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经会阴四维盆底超声动态成像对初产妇膀胱膨出疾病分级与分型的临床价值
郑小叶,张丹,谢晴,马敏涛,王文利
0
(西安市第三医院超声科;西安交通大学附属红会医院超声科)
摘要:
目的 探讨经会阴四维盆底超声动态成像对初产妇膀胱膨出疾病分级与分型的临床价值。方法 选取西安市第三医院2018年1月~2018年6月收治的盆底功能障碍性疾病(膀胱膨出)初产妇92例为研究对象,根据产妇的分娩方式分为经阴道分娩组(n=46)及剖宫产组(n=46)。在静息、屏气向下用力动作(Valaslva)及缩肛状态下观察两组患者膀胱尿道及盆膈裂孔的超声成像变化,测量膀胱相关参数数值并进行膀胱膨出Green分型。 结果 两组产妇经会阴盆底超声参数比较中,静止期BSD、尿道膀胱后角比较,差异均无统计学意义(均 P>0.05);剖宫产组产妇张力期BSD、尿道膀胱后角及膀胱颈移动度、尿道旋转角均明显小于经阴道分娩组产妇(均 P<0.05)。 经阴道分娩组产妇膀胱膨出Green分型中,Ⅰ型6例(13.04%),Ⅱ型26例(56.52%),Ⅲ型14例(30.43%);剖宫产组产妇膀胱膨出Green分型中,Ⅰ型14例(30.43%),Ⅱ型23例(50.00%),Ⅲ型9例(19.56%)。经阴道分娩组Ⅰ型膀胱膨出者明显少于剖宫产组,差异有统计学意义(P<0.05);而两组产妇Ⅱ型、Ⅲ型膀胱膨出例数比较,差异无统计学意义(P>0.05)。结论 经会阴四维盆底超声检查可清楚显示盆底解剖结构,有效区分不同分娩方式产妇的盆底Green类型,为临床制定治疗方案提供可靠的影像学资料。
关键词:  四维盆底超声  初产妇  膀胱膨出  疾病分级  Green分型
DOI:
基金项目:陕西省自然科学基金(2011K12 86;2010JM4016)
Clinical value of perineal four dimensional ultrasound pelvic floor dynamic imaging in the grading and classification of primiparas pelvic floor dysfunction
ZHENG Xiaoye,ZHANG Dan,XIE Qing,MA Mintao,WANG Wenli
(Department of Ultrasound, Xi′an No.3 Hospital;Department of Ultrasound, Red Cross Hospital Affiliated to Xi′an Jiao Tong University)
Abstract:
Objective To investigate the clinical value of perineal fourdimensional ultrasound pelvic floor dynamic imaging in the grading and classification of primiparas pelvic floor dysfunction. Methods 92 patients with primiparas pelvic floor dysfunction (bladder prolapse) were selected. According to the general data and imaging data, the women were divided into vaginal delivery group (n=46) and cesarean section group (n=46). The images of bladder and urethra and pelvic diaphragm hiatus at rest, valsalva maneuver and anal status were observed. The bladder related parameter and Green typing were performed. Results The resting corresponding BSD and posterior horn of bladder and urethra of the two groups had no statistic difference (t=0.498, 0.370; P=0.619, 0.370). Under valsalva state, the corresponding to BSD, posterior horn of bladder, the bladder neck mobility and urethra and rotation angle of the cesarean section group were lower than those of the vaginal delivery group (t=2.016, 3.792, 3.036, 3.786, P<0.05). According to the Green typing, the number of the type I, type Ⅱ and type Ⅲ in vaginal delivery group were 6 cases (13.04%), 26 cases (56.52%), and 14 cases (30.43%), which were significantly lower than 14 cases (30.43%), 23 cases (50.00%), and 9 cases (19.56%) in the cesarean section group, with statistic difference in the percentages between groups (x2=4.089, P=0.043), while no difference was found in the cystocele cases between the groups (x2=0.393, 3.737; P>0.05). Conclusion The perineal fourdimensional ultrasound pelvic floor dynamic imaging can clearly demonstrate the pelvic floor anatomy, which can effectively distinguish the pelvic floor Green type and provide reliable imaging data for primiparas pelvic floor dysfunction.
Key words:  Four dimensional pelvic floor ultrasound  Primiparas  Pelvic floor dysfunction  Disease grading  Green classification

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