符晓云 田瑞 周莹

摘要：目的：探究盆底三維超声评估不同分娩方式的初产妇产后的盆底解剖及功能变化的影响。方法：选择我院2018年7月至2020年7月期间收治的98例初产妇进行对比研究，按照分娩方式不同进行分组，一组是自然分娩组，一组是剖宫产组，每组49例初产妇，使用盆底三维超声对初产妇产后盆底解剖以及功能变化进行评估，对比超声检查结果，包括静息状态以及最大Valsalva动作状态下的盆底解剖情况，尿道倾斜角（UTA）、膀胱颈位置（BNP）、膀胱尿道后角（PUA）、尿道旋转角（URA），以及膀胱颈移动度（BND）、宫颈外口移动度（CDD）。结果：剖宫产组初产妇的BNP、CMP在静息状态下均高于自然分娩组，差异显著，具有统计学意义，P<0.05;在最大Valsalva动作状态下，剖宫产组的UTA小于自然分娩组，差异显著，具有统计学意义，P<0.05。两组初产妇的URA、BND以及CDD比较，剖宫产组URA优于自然分娩组，BNP、CMP高于自然分娩组，差异具有统计学意义，P<0.05，BND以及CDD比较差异不显著，无统计学意义，P>0.05。结论：运用盆底三维超声对自然分娩及剖宫产分娩初产妇的盆底解剖与功能变化进行评估，可以得到比较准确的评估结果，应用效果显著。

关键词：盆底三维超声;剖宫产;自然分娩;盆底解剖;盆底功能

Abstract： Objective： To explore the effect of three-dimensional ultrasound on pelvic floor anatomy and function of primiparas with different delivery methods. Methods： 98 cases of primipara in our hospital from July 2018 to July 2020 were selected for comparative study， and they were divided into two groups according to different delivery methods， one group was natural delivery group， the other group was cesarean section group， with 49 cases in each group Pelvic floor anatomy， urethral inclination angle（UTA）， bladder neck position（BNP）， posterior angle of bladder and urethra （PUA）， urethral rotation angle （URA）， bladder neck movement （Bnd） and cervical outer mouth movement （CDD） were measured under maximum Valsalva motion. Results： the BNP and CMP of primipara in the cesarean section group were higher than those in the natural delivery group in the resting state， with significant difference， with statistical significance， P<0.05; in the maximum Valsalva action state， the UTA in the cesarean section group was lower than that in the natural delivery group， with significant difference， with statistical significance， P<0.05. The URA， Bnd and CDD of primipara in the two groups were compared. The URA in the cesarean section group was better than that in the natural delivery group， and the BNP and CMP in the cesarean section group were higher than those in the natural delivery group， with statistical significance（P<0.05）. The Bnd and CDD were not significantly different， with no statistical significance （P>0.05）. Conclusion： using three-dimensional ultrasound to evaluate the pelvic floor anatomy and function changes of primiparas with natural delivery and cesarean section can get more accurate evaluation results， and the application effect is significant.

Key words： Three Dimensional Ultrasound of Pelvic Floor; Cesarean Section; Natural Delivery; Pelvic Floor Anatomy; Pelvic Floor Function

女性盆底功能障碍指的是女性盆底支持组织因退化、创伤等因素造成的支持薄弱，引发盆底功能障碍，对患者的生活质量造成严重影响[1]。女性盆底功能障碍的主要诱因就是妊娠和分娩，尤其是初产妇，如果产程时间过程或者产后没有获得足够、良好的休息，都会引起盆底功能障碍，导致盆腔脏器脱垂，例如阴道前后壁膨出、子宫脱垂以及压力性尿失禁等，影响患者日常生活，需要及时接受规范化治疗[2]。有研究表明[3]，女性盆底功能障碍与分娩方式有关，自然分娩出现盆底功能障碍的概率高于剖宫产。……