基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者，根据随机数字表法将患者分为两组，对照组（48例）采用盆底肌锻炼治疗，研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查，对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分，静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05），静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分，静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05），静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05），静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低，肛提肌厚度较治疗前增加，且与PFDI-20、PFIQ-7评分改善有关，经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。

Evaluate the Clinical Curative Effect of Biofeedback Electrical Stimulation Combined with Pelvic Floor Muscle Exercise in the Treatment of Postpartum Pelvic Floor Dysfunction Based on Transperineal Real-time Three-dimensional Ultrasound

ABSTRACT Objective: To explore the clinical curative effect of transperineal real-time three-dimensional ultrasound evaluation of biofeedback electrical stimulation combine with pelvic floor muscle exercise in the treatment of postpartum pelvic floor dysfunction. Methods: 96 postpartum pelvic floor dysfunction patients who were admitted to our hospital from September 2020 to September 2022 were selected, the patients were divided into two groups according to the random number table method, control group (48 cases) received pelvic floor muscle exercise treatment, study group (48 cases) treated with biofeedback electrical stimulation combined with pelvic floor muscle exercise. Transperineal real-time three-dimensional ultrasound examination before treatment and after treatment, the pelvic floor distress inventory (PFDI-20) scores, pelvic floor dysfunction impact simple questionnaire 7 (PFIQ-7) scores, rest and valsalva action states ultrasound parameters of levator ani muscle were compared between two groups before treatment and after treatment. The correlation between ultrasound parameters of levator ani muscle and PFDI-20 and PFIQ-7 scores were analyzed. Results: The scores of PFDI-20 and PFIQ-7, the anterior and posterior diameters of levator ani muscle hiatus, left and right diameters of levator ani muscle hiatus and the area of levator ani muscle hiatus at rest and Valsalva action states in two groups after treatment were lower than those before treatment (P<0.05), the thickness of levator ani muscle at rest state was increased compared with that before treatment (P<0.05). The scores of PFDI-20 and PFIQ-7, the anterior and posterior diameters of levator ani muscle hiatus, left and right diameters of levator ani muscle hiatus and the area of levator ani muscle hiatus at rest and Valsalva action states in study group after treatment were lower than those in control group (P<0.05), the thickness of levator ani muscle at rest state was greater than that in control group (P<0.05). The anterior and posterior diameters of levator ani muscle hiatus, left and right diameters of levator ani muscle hiatus and the area of levator ani muscle hiatus at rest and Valsalva action states were positively correlated with PFDI-20 and PFIQ-7 scores (P<0.05), the thickness of levator ani muscle at rest state were negatively correlated with PFDI-20 and PFIQ-7 scores (P<0.05). Conclusion: The size of levator ani muscle hiatus decrease after the treatment of biofeedback electrical stimulation combine with pelvic floor muscle exercise compare with before treatment, the thickness of the levator ani muscle increase compare with before treatment, and it is related to the improvement of PFDI-20 and PFIQ-7 scores, transperineal real time three-dimensional ultrasound can objectively and effectively evaluate the treatment effect of postpartum pelvic floor dysfunction patients.