经会阴三维超声评价不同分娩方式初产妇肛门括约肌复合体和盆膈裂孔的临床应用价值

摘要 目的：探讨经会阴三维超声在不同分娩方式初产妇肛门括约肌复合体（ASC）和盆膈裂孔（PH）影响的评估价值。方法：选择2017年1月～2019年12月我院进行分娩的初产妇150例，按照分娩方式分成阴道分娩组71例，剖宫产组79例，比较两组基线资料。对所有受试者均实施经会阴三维超声检查，比较两组缩肛动作下肛门内括约肌（IAS）远端、中端及远端平面厚度，肛门外括约肌（EAS）远端平面及耻骨直肠肌（PRM）中端平面厚度，分娩前、产后6周、产后3个月PH左右径、PH前后径以及PH面积。结果：两组孕妇年龄、孕周及体质指数比较无差异（P＞0.05），阴道分娩组IAS近端6点钟方向、12点钟方向平面厚度以及IAS中端、12点钟方向平面厚度均小于剖宫产组（P＜0.05）。阴道分娩组EAS远端12点钟方向平面厚度小于剖宫产组（P＜0.05）。阴道分娩组产后6周的PH左右径大于剖宫产组（P＜0.05）。阴道分娩组产后6周的PH前后径大于剖宫产组（P＜0.05）。阴道分娩组产后6周的pH面积大于剖宫产组（P＜0.05）。结论：经会阴三维超声可有效评估初产妇ASC和PH的影响情况，分娩会对初产妇ASC和PH产生影响，阴道分娩的初产妇产后存在明显的ASC厚度减小和PH增大现象。

The Clinical Value of Three-dimensional Transperineal Ultrasound in the Evaluation of Anal Sphincter Complex and Pelvic Diaphragmatic Hole in Primipara with Different Delivery Modes

ABSTRACT Objective: To investigate the evaluate value of of three-dimensional transperineal ultrasound on the influence of anal sphincter complex (ASC) and pelvic diaphragmatic hole (PH) in primary parturient women. Methods: Selected 150 primary parturient women in our hospital from January 2017 to December 2019, which were divided into vaginal delivery group with 71 cases and cesarean section group with 79 cases, the baseline data of the two groups were compared. Three-dimensional ultrasonography was performed on anal constriction. The thickness of the distal, middle and distal plane of the internal anal sphincter (IAS), the distal plane of the external anal sphincter (EAS) and the middle plane of the puborectal muscle (PRM), the PH left and right diameter, PH diameter and PH area before delivery, 6 weeks after delivery, 3 months after delivery were compared between the two groups. Results: There was no difference in age, gestational age and body mass index between the two groups (P>0.05), the plane thickness of proximal 6 o''clock, 12 o''clock and 12 o''clock of the middle of IAS in vaginal delivery group were lower than that in cesarean section group (P<0.05). The 12 o''clock plane thickness of the distal end of EAS in vaginal delivery group was lower than that in cesarean section group (P<0.05). The PH left and right diameter of vaginal delivery group at 6 weeks after delivery was larger than that of cesarean section group(P<0.05). The PH diameter of vaginal delivery group at 6 weeks after delivery was higher than that of cesarean section group(P<0.05). The PH area of vaginal delivery group at 6 weeks after delivery was higher than that of cesarean section group(P<0.05). Conclusion: Three-dimensional ultrasound can effectively evaluate the impact of ASC and PH in primipara. Delivery will have an impact on ASC and pH in primary parturient women. There is a significant decrease in ASC thickness and increase in PH in primipara after vaginal delivery.