妊娠晚期便秘女性盆底解剖结构及功能的三维超声动态观察

刘莉1 ，穆靓1，韦爱华1 ，南淑良1，管湘平1 ，李玢2 ，胡盈2，姜向阳2

（陕西省人民医院：1.超声科；2.妇产科，陕西 西安，710068）

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摘要：

目的 经会阴盆底三维超声动态观察妊娠晚期便秘孕妇的肛提肌裂孔解剖结构形态及功能改变。方法 选取2014年1月至2016年12月在我院妇产科定期行产前检查的单胎妊娠、孕37～4l 周的初产孕妇160例作为妊娠晚期组，其中便秘孕妇 58例，非便秘孕妇102例；同期选取未孕的健康妇女100例为对照组。两组妇女均进行经会阴盆底三维超声检查，测量比较各组妇女的盆底形态结构及特征。结果 妊娠晚期组孕妇盆底组织结构疏松，对照组妇女盆底组织结构完整紧凑。在静息状态、缩肛动作及Valsalva动作3种状态下，妊娠晚期组孕妇的肛提肌裂孔面积、周长及耻骨直肠肌厚度均明显大于对照组妇女（P<0.05）。妊娠晚期组便秘孕妇在3 种状态下的肛提肌裂孔面积及周长均明显大于非便秘孕妇（P<0.05）；在缩肛动作时，除便秘孕妇的耻骨直肠肌厚度明显薄于非便秘孕妇（P<0.05）外，其余状态下的耻骨直肠肌厚度两者间比较，差异均无统计学意义（P>0.05）。结论 妊娠晚期孕妇盆底解剖结构发生重塑，经会阴三维超声能有效观察妊娠晚期女性尤其便秘孕妇盆底 解剖结构与功能的变化情况。

关键词：妊娠晚期；便秘；盆底；三维超声

中图分类号：R445.1；R714.7文献标志码：A文章编号：2096-1413(2017)32-0001-04

Anatomical structure and function of pelvic floor in late pregnant women with constipation detected dynamically by transperineal three-dimensional ultrasonography
LIU Li 1, MU Liang 1, WEI Ai-hua 1, NAN Shu-liang 1, GUAN Xiang-ping 1, LI Bin 2, HU Ying 2, JIANG Xiang-yang 2


(1. Department of Ultrasound; 2. Department of Gynecology and Obstetrics, Shaanxi Provincial People``s Hospital, Xi``an 710068, China)

ABSTRACT: Objective To dynamically observe the anatomical structure and function of pelvic floor in late pregnant women with constipation by transperineal three-dimensional ultrasonography. Methods From January 2014 to December 2016, 160 primiparous pregnant women who was at 37-41 weeks of gestation and with single fetus were selected as the late pregnant group, including 58 pregnant women with constipation and 102 pregnant women without constipation. At the same period, 100 normal nulliparous healthy women were chosen as the control group. All the women received transperineal three-dimensional ultrasonography dectection, the anatomical structure and characteristics of pelvic floor of the pregnant women were measured and compared. Results The pelvic floor structure was loose in the late pregnancy group, and that was compact in the control group. In resting state, maximum pelvic floor contraction and maximum Valsalva, the perimeter and area of pelvic diaphragm hiatus and pubovisceral muscle thickness in the late pregnancy group were bigger than those in the control group (P<0.05). In the late pregnancy group, the perimeter and area of the pelvic diaphragm hiatus of the pregnant women with constipation were bigger than those of pregnant women without constipation at three maneuvers (P<0.05); pubovisceral muscle thickness in the pregnant women with constipation was significantly thinner than those in the pregnant women without constipation at maximum pelvic floor contraction (P<0.05); but there was no significant difference between the pregnant women with constipation and without constipation at resting state and maximum Valsalva in the pubovisceral muscle thickness (P>0.05). Conclusion Pelvic floor anatomic remodeling is identified in late pregnant women. Transperineal three-dimensional ultrasonography has great value for the observations of pelvic floor change in late pregnant women, especially pregnant women with constipation.
KEYWORDS：late-pregnancy women; constipation; pelvic floor; three-dimensional ultrasonography


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