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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。
Objective To assess the postpartum urethral mobility in primiparous female patients who underwent perineal three dimensional ultrasound. Methods One hundred and fiftieth pregnant women were randomly selected. One hundred and thirty-eight primiparous women were randomly divided into two groups: spontaneous delivery group (n = 70) and cesarean section group (n = 62) . The same period in our hospital obstetrics and gynecology outpatient due to irregular menstruation, vaginitis and other diseases of non-normal women treated 65 cases as a control group. Application of three-dimensional vaginal probe through the perineal to obtain resting state and Valsalva action volume of diaphragm diaphragm volume data imaging, to be later off-line analysis. Along the urethra walk, the urethra is divided into five equal parts, six markers, the bladder neck mouth marked the point 1 (U1), U2, U3, U4, U5, U6 urethral orifice , Respectively, measuring the displacement of the six markers to the lower edge of the pubic symphysis, and then calculate the movement of six markers. Two observers repeated the measurement of urinary tract mobility in 10 normal non-fertile women. Results Different observers had high repeatability and consistency of urethral mobility measurement with an ICC of 0.80. Valsalva action, postpartum female and non-sterile female urethral U 5 ~ 6 mobility are less than urethral proximal U 1 ~ 3 mobility, the difference was statistically significant (P <0.05). Postpartum urethra overall mobility than the control group increased, the difference was statistically significant (P <0.05). In the spontaneous labor group, the mobility of U 1 ~ 5 was higher than that in the cesarean section group, the difference was statistically significant (P <0.05). Conclusions Transurethral three-dimensional ultrasonography can effectively evaluate the urethral mobility of women. The distal urethral mobility of postpartum women and non-pregnant women with Valsalva is less than the proximal urethral mobility. The overall urethral mobility of postpartum women is increased, Increased mobility than cesarean section.