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刘晓志,孙雪松,吴　晨,等.多模态超声对产后女性盆底功能康复疗效的评价[J].同济大学学报（医学版）,2021,42(6):809-813. [点击复制]
LIU Xiao-zhi,SUN Xue-song,WU Chen,et al.Evaluation of efficacy of rehabilitation on pelvic floor function in postpartum women with multimodal ultrasonography[J].同济大学学报（医学版）,2021,42(6):809-813. [点击复制]

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多模态超声对产后女性盆底功能康复疗效的评价
刘晓志,孙雪松,吴　晨,张夏静,宋　烨
0 字体:加大+\|默认\|缩小-
(上海健康医学院附属周浦医院超声科，上海　201318)

摘要:

目的　通过经会阴盆底超声及实时剪切波弹性成像（shear wave elastography, SWE）观察产后女性康复治疗前后盆底前腔室及耻骨直肠肌弹性的变化，探讨不同治疗方式对产后女性盆底功能的影响。方法　选取2019年5月—2020年5月来上海健康医学院附属周浦医院进行产后复查，盆底超声提示膀胱脱垂(Ⅱ型)的女性共120例，并同时进行耻骨直肠肌弹性分析，根据患者是否进行盆底康复治疗的意愿，随机分为二组：康复治疗组和功能锻炼组。在治疗前后分别观察静息与Valsava状态下膀胱颈到耻骨联合后下缘的距离（Br，Bs）、尿道膀胱后角（Ar，As）、尿道旋转角（θ）、尿道漏斗消失率；静息与缩肛状态下耻骨直肠肌弹性对比，评价治疗效果。结果　康复治疗组治疗前后膀胱颈移动度Br减少（2±027）mm；Bs减少（11±066）mm；尿道膀胱后角Ar减少（16±021）°；As减少（60±031）°；尿道旋转角（θ）减少（24±017）°；尿道漏斗消失率90%（36/40）。功能锻炼组治疗前后膀胱颈移动度Br减少（2±007）mm；Bs减少（5±008）mm；尿道膀胱后角Ar减少（12±027）°；As减少（21±036）°；尿道旋转角（θ）减少（14±066）°；尿道漏斗消失率50%（20/40）（P<005）。康复治疗组静息期耻骨直肠肌杨氏模量值增加5±339（右），5±413（左）；缩肛期耻骨直肠肌杨氏模量值增加5±461（右），8±709（左）。功能锻炼组静息期耻骨直肠肌杨氏模量值增加1±101（右），2±113（左）；缩肛期耻骨直肠肌杨氏模量值增加2±213（右），2±193（左），差异有统计学意义（P<005）。通过治疗前后数据对比，康复治疗组优于功能锻炼组，两组患者治疗前后数据对比差异有统计学意义（P<005）。结论　盆底超声联合SWE在女性产后盆底功能康复疗效评估中的应用效果显著，能够清晰显示出产妇盆底诸结构，明确反映女性产后盆底肌损伤的恢复情况，有效评估治疗效果。

关键词: 产后盆底超声剪切波弹性成像杨氏模量值

DOI：10.12289/j.issn.1008-0932.21247

投稿时间：2021-06-18

基金项目:上海市浦东新区卫生系统领先人才培养计划(PWR12019-06)

Evaluation of efficacy of rehabilitation on pelvic floor function in postpartum women with multimodal ultrasonography

LIU Xiao-zhi,SUN Xue-song,WU Chen,ZHANG Xia-jing,SONG Ye

(Dept. of Ultrasonography, Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China)

Abstract:

Objective　To evaluate the efficacy of rehabilitation on pelvic floor function in postpartum women by transperineal pelvic floor ultrasound and real-time shear wave elastography（SWE). Methods　A total of 120 postpartum women with bladder prolapse（type Ⅱ) undergoing postpartum reexamination and pelvic floor ultrasonography in our hospital from May 2019 to may 2020 were enrolled in the study. The elasticity of puborectal muscle was analyzed at the same time. According to the willingness of patients for pelvic floor rehabilitation treatment, they were randomly divided into two groups： rehabilitation treatment group and functional exercise group. Before and after treatment, the distance from bladder neck to posterior lower edge of pubic symphysis（Br, Bs), urethral posterior bladder angle（Ar,As) and urethral rotation angle were measured in resting and Valsava state（θ). The disappearance rate of urethral funnel, the elasticity of puborectalis muscle in resting and anal contraction state were compared to evaluate the therapeutic effect. Results　In the rehabilitation group, the bladder neck movement br decreased by （2±027）mm； Bs decreased by （11±066）mm； Ar of posterior horn of urethra and bladder decreased by （16±021）°； As decreased by 60± 031； urethral rotation angle(θ) decreased by （24±017）°, the disappearance rate of urethral funnel（36/40) was 90%. In the functional exercise group, the Br of bladder neck movement decreased by （2±007）mm； Bs decreased by （5±008）mm； Ar of posterior horn of urethra and bladder decreased by （12±027）°； As decreased by （21±036）°； urethral rotation angle（θ) decreased by （14±066）°, the disappearance rate of urethral funnel（20/40) was 50%（P<005). In the rehabilitation group, the Youngs modulus of puborectalis muscle increased by 5±339(right) and 5±413(left); the Youngs modulus of puborectalis increased by 5±461(right) and 8±709(left); the Youngs modulus of puborectalis muscle increased by 1±101(right) and 2±113(left); the Youngs modulus of puborectalis increased by 2±213(right) and 2±193(left)（P<005). The parameters were significantly improved after treatment in both groups; while the improvement in rehabilitation treatment group was more marked than that in the functional exercise group（P<005) . Conclusion　Pelvic floor ultrasound combined with SWE can clearly show the structures of the maternal pelvic floor, reflect the recovery of pelvic floor muscle injury, and effectively evaluate the treatment effect in postpartum women.

Key words: postpartum pelvic ultrasound shear ware elastography Youngs modulus