【摘要】 目的 探讨四维盆底超声在评估初产妇孕晚期及分娩后盆膈裂孔变化中的作用。方法 选取唐山市妇幼保健院2019年1月至2020年12月182例孕晚期初产妇(观察组)与61例因月经不调就诊的未育女性(对照组)的临床资料进行回顾性研究，均进行四维盆底超声检查，观察盆膈裂孔前后径、左右径及面积；且根据不同分娩方式将观察组182例分为阴道分娩亚组(n=93)和择期剖宫产亚组(n=89)。对比静息、提肛、Valsulva状态下的盆膈裂孔参数变化，用ROC曲线分析该三项参数单独及联合评估盆膈裂孔形态的AUC值、敏感度、特异度。结果 观察组静息状态下盆膈裂孔前后径、左右径及面积高于对照组(P<0.01)。重复测量方差分析显示，盆膈裂孔三项参数间存在时间效应、组间效应(P<0.05);但时间(检测状态)因素和组间因素不具有交互效应(P>0.05);两两比较显示，在静息、提肛、Valsulva状态下，阴道分娩亚组的盆膈裂孔前后径、左右径及面积高于择期剖宫产亚组(P<0.05)。ROC曲线分析显示，盆膈裂孔前后径、左右径、面积以及三项参数单独和联合评估盆膈裂孔形态的AUC值分别为0.822、0.609、0.782和0.893,联合评估的AUC最高；敏感度分别为82.40%、23.10%、73.10%和78.00%;特异度分别为70.50%、100.00%、75.40%和93.40%。结论 四维盆底超声评估盆膈裂孔具有较高的临床价值，能为孕晚期孕产妇预防产后盆底功能障碍的发生提供指导。更多还原

【Abstract】 Objective To explore the role of four-dimensional pelvic floor ultrasound in evaluating the changes of pelvic diaphragmatic hiatus in primiparae during the late pregnancy and after delivery. Methods The clinical data of 182 primiparae in late pregnancy(observation group) and 61 nulliparous women who visited to the hospital due to irregular menstruation(control group) from January 2019 to December 2020 in Tangshan Maternal and Child Health Hospital were selected for retrospective study. All of them were examined with four-dimensional pelvic floor ultrasound to observe the anteroposterior diameters, left and right diameters and areas of pelvic diaphragmatic hiatus. According to different delivery methods, 182 cases were divided into vaginal delivery subgroup(n=93) and elective cesarean section subgroup(n=89). The changes of parameters of pelvic diaphragmatic hiatus at resting, anal lifting and Valsulva were compared, and the AUC value, sensitivity and specificity of these three parameters individually and jointly in evaluating the morphology of pelvic diaphragmatic hiatus were analysed by ROC curve. Results The anteroposterior diameter, left-right diameter and area of the pelvic diaphragmatic hiatus in the observation group at rest were higher than those in the control group(P<0.05). Variamce analysis of repeated measurements showed that there were time effects and inter group effects among the three parameters of pelvic diaphragmatic hiatus(P<0.05); however, there was no interaction between time(test state) and inter group factors(P>0.05); pairwise comparison between two groups showed that the anteroposterior diameter, left-right diameter and area of pelvic diaphragmatic hiatus in vaginal delivery subgroup were higher than those in elective cesarean section subgroup at resting, anal lifling and Valsulava(P<0.05). ROC curve analysis showed that the AUC values of anteroposterior diameter, left-right diameter, area and three parameters individually and jointly for evaluating the shape of pelvic diaphragmatic hiatus were 0.822, 0.609, 0.782 and 0.893 respectively, and the AUC value of joint evaluation was the highest; and the sensitivity was 82.40%, 23.10%, 73.10% and 78.00%, respectively; the specificities were 70.50%, 100.00%, 75.40% and 93.40%, respectively. Conclusion Four-dimensional pelvic floor ultrasound evaluation of pelvic diaphragmatic hiatus has a high clinical value, which can provide guidance for late pregnant women to prevent the occurrence of postpartum pelvic floor dysfunction.更多还原