王小英　李晓珍　林木珍　丘伟玲　李梅清

【摘要】 目的：探討经会阴二维联合三维超声分析胎儿体质量对单胎经阴道分娩初产妇盆底结构的影响。方法：选取2019年9月-2020年3月本院收治的单胎经阴道分娩初产妇86例为研究对象，根据新生儿出生时体质量将51例正常体质量儿（出生体重3 000～3 999 g）纳入对照组，35例巨大儿（出生体重≥4 000 g）纳入观察组。两组于产后第42天行经会阴二维联合三维超声检查。比较两组肛提肌裂孔情况、耻骨内脏肌厚度及盆腔脏器脱垂（POP）发生情况。结果：观察组静息和Valsalva动作状态下肛提肌裂孔的前后径、左右径和面积均高于对照组，耻骨内脏肌左侧、右侧厚度均低于对照组，差异均有统计学意义（P<0.05）。观察组POP发生率低于对照组，差异有统计学意义（P<0.05）。结论：巨大儿对单胎经阴道分娩初产妇的盆底结构影响较明显，经会阴二维联合三维超声可早期、准确地评估肛提肌损伤及产后轻度盆底功能障碍。

【关键词】 经会阴 二维超声 三维超声 胎儿体质量 单胎 经阴道分娩 初产妇 盆底结构

[Abstract] Objective： To explore the influence of transperineal two-dimensional and three-dimensional ultrasound analysis on fetal body mass on the structure of the pelvic floor of primiparous women in singleton transvaginal delivery. Method： A total of 86 cases of single parturients with vaginal delivery admitted to our hospital from September 2019 to March 2020 were selected as the research subjects， according to the birth weight of newborns， 51 cases of normal body weight （birth weight of 3 000-3 999 g） were included in the control group， 35 cases of macro-neonates （birth weight≥4 000 g） were included in the observation group. Two groups of women underwent perineal two-dimensional and three-dimensional ultrasound examination on the 42nd day after delivery. The levator ani muscle holes， pubic visceral muscle thickness and pelvic organ prolapse （POP） were compared between two groups. Result： The anteroposterior diameter， left and right diameter ， area of levator ani hiatus in the observation group were higher than those in the control group at resting and Valsalva， the thickness of left and right pubic visceral muscle were lower than those in the control group， the differences were statistically significant （P<0.05）. The incidence of POP in the observation group was lower than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： Macro-neonates have a significant effect on the pelvic floor structure of primiparous women with singleton transvaginal delivery， two-dimensional perineal combined with three-dimensional ultrasound can early and accurately assess levator ani muscle injury and postpartum mild pelvic floor dysfunction.

[Key words] Transperineal Two-dimensional ultrasound Three-dimensional ultrasound Fetal body mass Singleton Transvaginal delivery Primipara Pelvic floor structure

First-authors address： Maternal and Child Health Hospital of Lianjiang City， Lianjiang 524400， China

doi：10.3969/j.issn.1674-4985.2021.09.040

盆底由肛提肌、尾骨肌和内、外筋膜构成，对维持盆底器官正常位置起着关键作用[1]。一旦发生盆腔支持结构退化或缺陷、损伤，可导致盆底功能障碍性疾病（pelvic floor dysfunction，PFD），表现为盆腔器官脱垂、尿失禁、性功能障碍等[2]。妊娠和分娩是引发PFD的主要原因，其中胎儿体质量是诱发因素之一，会导致增加腹压、损伤盆底结构，从而使得盆底结构与功能受到影响，严重影响到产妇的生活质量及社会交往状况[3-4]。因此，早期、准确的检查方式对盆底结构改变进行评估具有重要意义。随着近年来影像技术的不断发展，三维超声逐渐应用到妇科疾病的诊断中，可直接观察盆底结构的变化情况，准确评估盆腔脏器及肌肉的功能[5-6]。……