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      标题:不同分娩方式产妇产后三维联合二维超声表现及产后并发症分析
      作者:任艳 1,申倩 2,桂红 1,王琰 1    任艳 1,申倩 2,桂红 1,王琰 1渭南市中心医院超声科 1、产科 2,陕西 渭南 714000
      卷次: 2023年34卷9期
      【摘要】 目的 分析不同分娩方式产妇产后三维联合二维超声表现及产后并发症状况。方法 回顾性分析2021年6月至2022年5月在渭南市中心医院产科分娩并进行产后修复的80例产妇的临床资料。按照不同分娩方式分为对照组(剖宫产)和研究组(经阴道自然分娩)各40例。在产妇分娩6周后,采用盆底三维联合二维超声检查比较两组产妇分别在静息状态、最大Valsalva状态、最大缩肛状态下肛提肌裂孔的前后径(LHAP)、肛提肌裂孔的左右径(LHLD)、肛提肌裂孔的面积(LHA)、左侧肛提肌厚度(LAT)、右侧肛提肌厚度(LAT),以及两组产妇盆腔功能指标[尿道旋转角(URA)、膀胱颈移动度(BND)、宫颈外口移动度(CDD)],并比较两组产妇盆腔器官脱垂和压力性尿失禁的发生率。结果 静息状态下,研究组产妇的LHAP、LHLD、LHA、左侧肌LAT、右侧肌LAT分别为(4.39±0.42) cm、(5.41±0.49) cm、(15.13±2.15) cm2、(0.69±0.12) cm、(0.64±0.09) cm,明显长(大)于对照组的(3.80±0.31)cm、(4.74±0.36) cm、(13.08±2.45) cm2、(0.54±0.11) cm、(0.56±0.10) cm,差异均有统计学意义(P<0.05);最大Valsalva状态下,研究组产妇的LHAP、LHLD、LHA、左侧肌LAT、右侧肌LAT分别为(4.69±0.36) cm、(5.91±0.44) cm、(18.13±2.22) cm2、(0.59±0.10) cm、(0.58±0.12) cm,明显长(大)于对照组的(4.02±0.41) cm、(5.14±0.56) cm、(16.08±2.18) cm2、(0.51±0.09) cm、(0.49±0.10) cm,差异均有统计学意义(P<0.05);最大缩肛状态下,研究组产妇的LHAP、LHLD、LHA、左侧肌LAT、右侧肌LAT分别为(3.95±0.41) cm、(4.85±0.45) cm、(13.18±1.98) cm2、(0.68±0.08) cm、(0.71±0.12) cm,明显长(大)于对照组的(3.50±0.32) cm、(4.51±0.41) cm、(11.02±1.89) cm2、(0.60±0.07) cm、(0.62±0.10) cm,差异均有统计学意义(P<0.05);研究组产妇的URA、BND、CDD分别为(41.82±9.19) mm、(16.89±3.12) mm、(13.11±2.98) mm,明显高于对照组的(32.01±8.81) mm、(14.20±3.05) mm、(10.68±2.58) mm,差异均有统计学意义(P<0.05);研究组产妇盆腔器官脱垂的发生率、压力性尿失禁发生率分别为47.5%、45.0%,明显高于对照组的15.0%、12.5%,差异均具有统计学意义(P<0.05)。结论 不同分娩方式产妇产后三维联合二维超声检查中,经阴道自然分娩产妇肛提肌裂孔形态较选择性剖宫产产妇增大,有效提高产后并发症检出率,能为疾病预防提供临床指导。
      【关键词】 盆底三维超声;盆底二维超声;不同分娩方式;阴道分娩;剖宫产;并发症
      【中图分类号】 R714.46 【文献标识码】 A 【文章编号】 1003—6350(2023)09—1303—05

Analysis of three-dimensional combined with two-dimensional ultrasound findings and postpartumcomplications of parturients with different delivery modes.

REN Yan 1, SHEN Qian 2, GUI Hong 1, WANG Yan 1.Department of Ultrasound 1, Department of Obstetrics 2, Weinan Central Hospital, Weinan 714000, Shaanxi, CHINA
【Abstract】 Objective To analyze the three-dimensional combined with two-dimensional ultrasound findingsand postpartum complications of parturients with different delivery modes. Methods The clinical data of 80 parturientswho delivered and underwent postpartum repair in Weinan Central Hospital from June 2021 to May 2022 were analyzedretrospectively. According to different delivery methods, they were divided into a control group (cesarean section) and astudy group (vaginal natural delivery), each with 40 cases. After 6 weeks of delivery, the pelvic floor three-dimensionalcombined with two-dimensional ultrasound was used to compare the anteroposterior diameter (LHAP), left and right di-ameter (LHLD), surface area (LHA), left levator ani muscle thickness (LAT), and right levator ani muscle thickness(LAT) of the two groups of parturients in resting state, maximum Valsalva state, and maximum anal contraction state,respectively, as well as the pelvic function indexes [urethral rotation angle (URA), bladder neck descent (BND), andcervical outer opening mobility (CDD)] and the incidence of pelvic organ prolapse and stress urinary incontinence.Results At rest, the LHAP, LHLD, LHA, left muscle LAT, and right muscle LAT of the study group were (4.39±0.42) cm,(5.41±0.49) cm, (15.13±2.15) cm2, (0.69±0.12) cm, (0.64±0.09) cm , which were significantly longer (larger) than (3.80±0.31) cm,(4.74±0.36) cm, (13.08±2.45) cm2, (0.54±0.11) cm, (0.56±0.10) cm of the control group (P<0.05). In the state of maxi-mum Valsalva, the LHAP, LHLD, LHA, left muscle LAT, and right muscle LAT of the study group were (4.69±0.36) cm,(5.91±0.44) cm, (18.13±2.22) cm, (0.59±0.10) cm, (0.58±0.12) cm, which were significantly longer (larger) than (4.02±0.41) cm, (5.14±0.56) cm, (16.08±2.18) cm, (0.51±0.09) cm, (0.49±0.10) cm of the control group (P<0.05). Under thecondition of maximum anal contraction, the LHAP, LHLD, LHA, left muscle LAT, and right muscle LAT of the studygroup were (3.95±0.41) cm, (4.85±0.45) cm, (13.18±1.98) cm2, (0.68±0.08) cm, (0.71±0.12) cm, which were significant-ly longer (larger) than (3.50±0.32) cm, (4.51±0.41) cm, (11.02±1.89) cm2, (0.60±0.07) cm, and (0.62±0.10) cm of thecontrol group (P<0.05). The URA, BND, and CDD of pregnant women in the study group were (41.82 ± 9.19) mm,(16.89±3.12) mm, and (13.11±2.98) mm, which were significantly higher than (32.01±8.81) mm, (14.20±3.05) mm, and(10.68±2.58) mm in the control group (P<0.05). The incidence of pelvic organ prolapse and stress urinary incontinencein the study group were 47.5% and 45.0%, which were significantly higher than 15.0% and 12.5% in the control group(P<0.05). Conclusion In the three-dimensional and two-dimensional ultrasound examination of postpartum women withdifferent delivery modes, the shape of levator ani muscle fissure in women with vaginal natural delivery is larger than thatin women with selective cesarean section, which effectively improves the detection rate of postpartum complications andcan provide clinical guidance for disease prevention.
      【Key words】 Pelvic floor three-dimensional ultrasound; Pelvic floor two-dimensional ultrasound; Different deliv-ery modes; Vaginal delivery; Cesarean section; Complication

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