【摘要】 目的探讨MRI对不同分娩方式产妇产后早期盆底改变及恢复的评价效果。方法选取符合纳入及排除标准的产妇120例,根据分娩方式分为阴道分娩组和剖宫产组两组各60例。应用3.0 T MRI评估比较两组产后6和10周时盆底结构、肛提肌损伤情况,产后10周静息状态及用力状态下肛提肌收缩情况,以及产后3个月盆腔脏器脱垂及压力性尿失禁发生情况。结果产后6周时,阴道分娩组直肠后壁耻骨直肠肌附着点到耻骨联合下缘与骶尾关节连接点连线的垂直距离(M线)、膀胱最远端到耻骨联合下缘与骶尾关节连接点连线的垂直距离(B-PCL)、子宫颈到耻骨联合下缘与骶尾关节连接点连线的垂直距离(U-PCL)及肛提肌裂隙面积(LHS)均长于或大于剖宫产组;产后10周时,阴道分娩组M线、U-PCL及LHS均长于或大于剖宫产组,差异具有统计学意义(P<0.05)。产后10周时,两组M线、B-PCL、U-PCL及LHS均短于或小于产后6周时,差异具有统计学意义(P<0.05)。产后6周时,阴道分娩组肛提肌损伤率高于剖宫产组,差异有统计学意义(P<0.05)。阴道分娩组肛提肌损伤率产后10周时低于产后6周时,差异有统计学意义(P<0.05)。产后10周时,静息和用力状态下,阴道分娩组和剖宫产组耻骨直肠肌厚度和提肛板角比较差异无统计学意义(P>0.05)。产后3个月时,两组盆腔脏器脱垂及压力性尿失禁发生率比较差异均无统计学意义(P>0.05)。结论 MRI是评价产后盆底改变及恢复的良好方法。阴道分娩和剖宫产均可导致产妇产后盆底结构改变,阴道分娩对产后早期盆底结构负面影响更大,早期盆底康复训练有利于改善产妇盆底结构及功能。更多还原

【Abstract】 Objective To explore the evaluation effects of magnetic resonance imaging(MRI) on early pelvic floor changes and recovery of puerperae with different delivery modes. Methods A total of 120 puerperae who met the inclusion and exclusion criteria were selected and divided into vaginal delivery group(n=66) and cesarean section(C-section) group(n=54) according to the delivery modes. 3.0 T MRI was used to compare the pelvic floor structure and levator ani muscle(LAM) injury at 6 w and 10 w after delivery, the LAM contraction at resting and at forcing at 10 w after delivery and the pelvic organ prolapse and stress urinary incontinence(SUI) at 3 months after delivery. Results At 6 w after delivery, the M line(the perpendicular distance between posterior rectal puborectal muscle attachment point to inferior margin of pubic symphysis and to junction of sacrococcygeal joint line), B-PCL(the perpendicular distance between the distal end of bladder to inferior margin of pubic symphysis and to junction of sacrococcygeal joint line), U-PCL(the perpendicular distance between cervix to inferior margin of pubic symphysis and to junction of sacrococcygeal joint line) and LHS(levatorhiatus size) in vaginal delivery group were longer or higher than those in C-section group(P<0.05). At 10 w after delivery, the M line, U-PCL and LHS in vaginal delivery group were longer or higher than those in C-section group(P<0.05). At 10 w after delivery, the M line, B-PCL, U-PCL and LHS in the two groups were shorter or lower than those at 6 w after delivery, and there were significant differences(P<0.05). At 6 w after delivery, the rate of LAM injury in vaginal delivery group was higher than that in C-section group(P<0.05). At 10 w after delivery, the rate of LAM injury in vaginal delivery group was lower than that at 6 w after delivery, suggesting significant differences(P<0.05). At 10 w after delivery, there were no significant differences in puborectalis thickness(PRT) and levator ani plate angle(LPA) between vaginal delivery group and C-section group at resting and at forcing(P>0.05). At 3 months after delivery, there were no significant differences in the incidence rates of pelvic organ prolapse and SUI between the two groups(P>0.05). Conclusion MRI is a good method to evaluate the changes and recovery of pelvic floor after childbirth. Both vaginal delivery and cesarean delivery can lead to changes in pelvic floor structure after delivery. However, vaginal delivery has a greater negative impact on the structure of pelvic floor in the early postpartum period. Early pelvic floor rehabilitation training is beneficial to improve the structure and function of pelvic floor.更多还原