【摘要】 目的评估经会阴三维超声对初产女性产后尿道移动度。方法选择单胎妊娠、定期在该院产科检查并分娩的初产妇132例,根据分娩方式不同,分为自然分娩组(70例)及剖宫产组(62例),两组患者作为产后组。同期选择在我院妇产科门诊因月经不调、阴道炎等疾病就诊的正常未育女性65例作为对照组。应用三维阴道探头经会阴获取静息状态及Valsalva动作时盆膈裂孔容积数据成像,待后期离线分析。沿着尿道走行,将尿道分为五等份、六个标志点,即膀胱颈内口为标志点1(U 1)、U 2、U 3、U 4、U 5、尿道外口为U 6,分别测量这六个标志点到耻骨联合下缘的位移,再计算出六个标志点的移动度。由2名观察者对10例正常未育女性尿道移动度进行重复测量。结果不同观察者对尿道移动度的测量结果重复性高、一致性好,组内相关系数(ICC)为0.80。Valsalva动作时,产后女性及未育女性尿道远端U 5~6移动度均小于尿道近端U 1~3移动度,差异有统计学意义(P<0.05)。产后组尿道整体移动度较对照组增大,差异有统计学意义(P<0.05)。自然分娩组U 1~5移动度较剖宫产组增大,差异有统计学意义(P<0.05)。结论经会阴三维超声能够有效评估女性尿道移动度;Valsalva动作时产后女性及未育女性尿道远端移动度均小于尿道近端移动度;产后女性尿道整体移动度增加,自然分娩组U 1~5移动度较剖宫产组增大。更多还原

【Abstract】 Objective To evaluate urethral mobility of postpartum women by transperineal three- dimensional ultrasonography.Methods A total of 132 primiparous women( single pregnancy) receiving prenatal examination regularly and giving birth to their babies in the hospital were selected as postpartum group and divided into spontaneous labor group( 70 women) and cesarean section group( 62women) according to delivery modes; sixty- five normal nulliparous women going to the hospital because of irregular menstruation,vaginitis during the same period were selected as control group. Transperineal three- dimensional ultrasonography was used to obtain volume data imaging of pelvic diaphragmatic hiatus in quiescent condition and during Valsalva’s test,then offline analysis was performed. Urethra was divided into five segments equally along the course of urethra,there were six signalized points: U1( internal opening of bladder neck),U2,U3,U4,U5,U6( orificium urethrae externum); the distances from the six signalized points to lower margin of pubic bone were measured respectively,then the mobility of the six signalized points was calculated; two observers repeatedly measured urethral mobility of ten normal nulliparous women. Results The repetitiveness of measuring results of different observers for urethral mobility was high,the uniformity was good,intra- class correlation coefficient( ICC) was 0. 80. The urethral mobility at U5- 6 signalized points of postpartum women and nulliparous women was less than that at U1- 3 signalized points during Valsalva’s test( P < 0. 05). The overall urethral mobility in postpartum group was statistically significantly larger than that in control group( P < 0. 05). The urethral mobility at U1- 5 signalized points in spontaneous labor group was statistically significantly larger than that in cesarean section group( P < 0. 05). Conclusion Transperineal three- dimensional ultrasonography can effectively evaluate maternal urethral mobility. The distal urethral mobility of postpartum women and nulliparous women was less than proximal urethral mobility during Valsalva’s test; the overall urethral mobility of postpartum women increased,urethral mobility at U1- 5 signalized points in spontaneous labor group was larger than that in cesarean section group.更多还原