2026 年第 10 期 第 21 卷

多维指标评估不同分娩方式对初产妇产后早期盆底结构及功能的影响

Multidimensional index evaluation of the effects of different delivery modes on pelvic floor structure and function in primiparas during early postpartum period

作者：杨凯凯马正梅刘亚琴杨佳辰王淑婷陆晓莉

英文作者：Yang Kaikai Ma Zhengmei Liu Yaqin Yang Jiachen Wang Shuting Lu Xiaoli

单位：北京大学第一医院宁夏妇女儿童医院盆底康复科，银川750000

英文单位：Department of Pelvic Floor Rehabilitation Ningxia Women and Children′s Hospital Peking University First Hospital Yinchuan 750000 China

关键词：自然分娩；选择性剖宫产；盆底三维超声；盆底肌电评估；盆腔器官脱垂

英文关键词：Spontaneousdelivery;Electivecesareansection;Three-dimensionalpelvicfloorultrasound;Pelvicfloormuscleelectromyographicassessment;Pelvicorganprolapse

• 摘要：

• 目的  探讨不同分娩方式对初产妇产后早期盆底结构及功能的影响。方法 回顾性选取2024年11月至2025年11月于北京大学第一医院宁夏妇女儿童医院盆底康复科进行产后常规筛查评估的受试者246例。根据分娩方式的不同分为自然分娩组（120例）和剖宫产组（126例）。比较2组受试者一般临床资料、盆底三维超声指标、盆腔器官脱垂定量分度、盆底表面肌电检测、盆底功能障碍问卷情况。结果 2组受试者一般资料比较差异均无统计学意义(均P＞0.05)。剖宫产组尿道倾斜角、膀胱尿道后角、尿道旋转角、膀胱颈移动度、肛提肌裂孔面积均小于自然分娩组，差异均有统计学意义（均P＜0.05）。剖宫产组漏斗形成、压力性尿失禁、膀胱膨出及子宫脱垂比例均低于自然分娩组［4.0%（5/126）比11.7%（14/120）、0.8%（1/126）比6.7%（8/120）、25.4%（32/126）比70.8%（85/120）、38.1%（48/126）比51.7%（62/120）］，差异均有统计学意义（χ2=5.110，P=0.024； χ2=4.464，P=0.035； χ2=50.870，P＜0.001； χ2=4.579，P=0.032）。剖宫产组Ⅰ度阴道前壁、阴道后壁脱垂发生率均高于自然分娩组，Ⅱ度阴道前壁、阴道后壁脱垂、Ⅰ度子宫脱垂发生率均低于自然分娩组，差异均有统计学意义（均P＜0.05）。2组盆底功能障碍问卷评分比较差异均无统计学意义（均P＞0.05）。结论 多维评估下两种分娩方式对初产妇产后盆底结构及功能的影响以前盆腔更显著，自然分娩者需重点加强产后早期盆底功能的筛查与康复干预。

• Objective To investigate the effects of different delivery modes on pelvic floor structure and function in primiparas during early postpartum period. Methods A total of 246 subjects who underwent routine postpartum screening and evaluation in the Department of Pelvic Floor Rehabilitation, Ningxia Women and Children′s Hospital, Peking University First Hospital from November 2024 to November 2025 were retrospectively selected. According to different delivery modes, they were divided into spontaneous delivery group (120 cases) and cesarean section group (126 cases). General clinical data, three-dimensional pelvic floor ultrasound indicators, pelvic organ prolapse quantification staging, pelvic floor surface electromyography assessment reports, and pelvic floor dysfunction questionnaire scores were compared between the two groups. Results There were no statistically significant differences in general data between the two groups (all P>0.05). The urethral inclination angle, posterior vesicourethral angle, urethral rotation angle, bladder neck mobility, and levator ani hiatus area in the cesarean section group were less than those in the spontaneous delivery group (all P<0.05). The proportions of funnel formation, stress urinary incontinence, cystocele and uterine prolapse in the cesarean section group were lower than those in the spontaneous delivery group ［4.0%(5/126) vs 11.7%(14/120), 0.8%(1/126) vs 6.7%(8/120), 25.4%(32/126) vs 70.8%(85/120), 38.1%(48/126) vs 51.7%(62/120)］(χ2=5.110, P=0.024; χ2=4.464, P=0.035; χ2=50.870, P<0.001; χ2=4.579, P=0.032). The incidence rates of grade Ⅰ anterior vaginal wall prolapse and posterior vaginal wall prolapse in the cesarean section group were higher than those in the spontaneous delivery group, while the incidence rates of grade Ⅱ anterior vaginal wall prolapse, posterior vaginal wall prolapse and grade Ⅰ uterine prolapse were lower than those in the spontaneous delivery group (all P<0.05). There were no statistically significant differences in pelvic floor dysfunction questionnaire scores between the two groups (all P>0.05). Conclusion Under multidimensional evaluation, the effects of the two delivery modes on postpartum pelvic floor structure and function in primiparas are more significant in the anterior pelvic compartment. Primiparas with spontaneous delivery need focused strengthening of early postpartum pelvic floor function screening and rehabilitation intervention.