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目的:探讨不同分娩方式对生殖裂孔形态和肛提肌功能的影响。方法:选取2009年8月-2009年12月在广州医学院第一附属医院产科分娩的初产妇32例,其中选择性剖宫产21例,阴道自然分娩11例,同期选择健康未生育妇女13例为对照组。前两组均在产后12周选择3种不同状态下(静态、Valsalva动作时及肛提肌最大收缩状态),采用会阴三维超声检测生殖裂孔的直径(LHD)、前后径(LHAP)、横径(LHLR)、周长(LHC)及尿道中点至肛提肌的距离(LUG),计算肛提肌弹性εcont,阴道指诊评估肛提肌收缩时的肌力。结果:选择性剖宫产组、阴道自然分娩组分别与对照组比较,生殖裂孔各径线超声检测结果均大于对照组,肛提肌肌力和肛提肌弹性小于对照组(均P<0.05)。选择性剖宫产组与阴道自然分娩组比较,会阴超声检测生殖裂孔的LHD、LHAP、LHLR、LHC、LUG,肛提肌弹性等差异3组均无统计学(P>0.05),但肛提肌肌力等级较阴道自然分娩组高(P<0.05)。结论:选择性剖宫产和阴道自然分娩者产后均存在生殖裂孔形态学变化,提示妊娠及分娩均存肛提肌损伤,选择性剖宫产对盆底保护作用有限。
Objective: To investigate the effect of different modes of delivery on reproductive foramina and levator ani muscle function. Methods: 32 cases of primipara were delivered from August 2009 to December 2009 in the obstetrical department of Guangzhou First Affiliated Hospital of Guangzhou Medical College. Among them, 21 cases were elective cesarean section and 11 cases were spontaneous vaginal delivery. Example for the control group. The first two groups were selected three different states (static state, Valsalva motion and the maximum contraction of the levator ani muscle) at 12 weeks postpartum. The perineal three-dimensional ultrasonography was used to detect the diameter of the reproductive foramen (LHD), anteroposterior diameter (LHAP) (LHLR), circumference (LHC) and the distance from the midpoint of the urethra to the levator ani muscle (LUG) were calculated, and the levator ani elasticity εcont was calculated. Results: Compared with the control group, the selective cesarean section and vaginal spontaneous delivery group were significantly higher than those of the control group (P <0.05, P <0.05) ). There was no significant difference between the selective cesarean section group and the spontaneous vaginal delivery group in the three groups of LHD, LHAP, LHLR, LHC, LUG and levator ani elasticity (P> 0.05) Muscle strength than vaginal natural delivery group (P <0.05). CONCLUSION: Morphological changes of reproductive foraminifera are present in both selective cesarean section and vaginal spontaneous delivery, which suggests that levator ani muscle injury occurs in both pregnancy and childbirth. Selective cesarean section has limited protective effect on pelvic floor.