目的 经会阴盆底三维超声动态观察便秘产妇的肛提肌裂孔解剖形态及功能改变。方法 选取2014-01至2016-12在妇产科定期行产后复查的女性120例(产后组),其中有便秘症状48例(便秘产妇),无便秘症状72例(无便秘产妇),同期选取未育的无便秘症状健康妇女100例(对照组)。所有妇女均进行经会阴盆底三维超声检查,观察并测量、比较各组妇女的盆底形态结构及特征,测量各组妇女在静息状态、缩肛动作和Valsalva动作3种状态下的肛提肌裂孔面积、周长及耻骨直肠肌厚度。结果 产后妇女盆底组织结构疏松,对照组妇女肛提肌裂孔结构完整紧凑。在静息状态、缩肛动作及Valsalva动作3种状态下,产后组妇女的肛提肌裂孔面积、周长及耻骨直肠肌厚度均明显大于对照组妇女(P<0.05)。产后组便秘产妇在各种状态下的肛提肌裂孔面积及周长均明显大于非便秘产妇(P<0.05);在缩肛动作时,便秘产妇的耻骨直肠肌厚度明显薄于非便秘产妇(t=2.41,P<0.05),其余状态下的耻骨直肠肌厚度两者间比较,差异均无统计学意义(P＞0.05)。结论 产后妇女盆底解剖结构发生重塑,经会阴三维超声能有效观察产后女性尤其便秘产妇盆底解剖结构与功能的变化。

Objective To observe dynamically the morphological characteristics of the pelvic diaphragm hiatus in postpartum women with constipation by transperineal three-dimensional ultrasonography.Methods One hundred and twenty postpartum women who underwent transperineal 3-D ultrasound examination at the Department of Obstetrics and Gynecology between January 2014 and December 2016,including 48 postpartum women with constipation and another 72 postpartum women without constipation, were selected as the subjects.In the meantime,100 normal nulliparous healthy women without constipation were chosen as the control group.The morphological characteristics, perimeter and area of the pelvic diaphragm hiatus as well as pubovisceral muscle thickness were measured at rest, on maximum pelvic floor contraction and maximum Valsalva by 3-D ultrasound, respectively.Results Loose connective tissue was observed in postpartum women.The perimeter and area of the pelvic diaphragm hiatus and pubovisceral muscle thickness were increased more significantly in postpartum women than in the control group at rest, on maximum pelvic floor contraction and maximum Valsalva respectively (P<0.05).The perimeter and area of the pelvic diaphragm hiatus in postpartum women with constipation were increased more considerably than in those without constipation during the three maneuvers,respectively(P<0.05).Pubovisceral muscle thickness in postpartum women with constipation was significantly thinner than that of those without constipation at maximum pelvic floor contraction(t=2.41, P<0.05), but there was no significant difference between postpartum women with constipation and those without constipation at rest and on maximum Valsalva in pubovisceral muscle thickness (P＞0.05).Conclusions Pelvic floor anatomic remodeling is identified in postpartum women.Transperineal three-dimensional ultrasonography is of great value for observing pelvic floor changes in postpartum women, especially in postpartum women with constipation.