动态磁共振成像测量骨盆耻尾线评估盆腔器官脱垂程度的临床价值  

Clinical study on pubococcygeal line determined by dynamic magnetic resonance imaging used in evaluating pelvic organ prolapse

作　　者：苗娅莉[1] 张晓红[1] 武靖[2] 康钰[2] 洪楠[2] 王建六[1] 

机构地区：[1]北京大学人民医院妇科,100044 [2]北京大学人民医院放射科,100044

出　　处：《中华妇产科杂志》2010年第12期900-903,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：卫生部临床学科重点项目（2007-353）;首都医学发展科研基金（2007-2010）

摘　　要：目的 初步了解动态磁共振成像（MRI）测量骨盆耻尾线（PCL）评估盆腔器官脱垂（POP）程度的临床价值.方法 对20例POP患者分别进行POP定量（POP-Q）分度法测量,同时行动态MRI检查,用梯度回波二维快速小角度激发成像（FLASH）T1加权快速扫描序列,获得静息和用力屏气期间盆底矢状面MRI影像,分别测量骨盆PCL以评仙阴道前壁脱垂、子宫脱垂和阴道后壁脱垂的程度,并与POP-Q分度法的结果进行比较.结果 20例POP-Q分度法诊断为阴道前壁脱垂的患者,在最大屏气用力时,17例患者的膀胱颈或膀胱最低点位于PCL以下,与POP-Q分度法的符合率为85%（17/20）.19例POP-Q分度法诊断为阴道后壁脱垂的患者,最大屏气用力时,4例患者的肛直肠连接部下降至PCL下2.5 cm之下,与POP-Q分度法的符合率为4/19.14例POP-Q分度法诊断为子宫脱垂的患者,最大屏气用力时,宫颈最低点均位于PCL上l cm以下,与POP-Q分度法的符合率为14/14,但有5例POP-Q分度法未诊断子宫脱垂的患者,宫颈最低点位置在最大屏气用力时位于PCL上1 cm以下.结论 与POP-Q分度法相比,采用动态MRI检查中的骨盆PCL作为标志线,可以准确判定子宫脱垂的程度,对阴道前壁脱垂也有一定的临床参考价值,而对阴道后壁脱垂则有一定的局限性.因此,动态MRI测量骨盆PCL评估POP程度的临床价值有待进一步研究.Objective To investigate clinical value of pubococcygeal line （PCL） determined by dynamic magnetic resonance imaging （MRI） used in evaluating pelvic organ prolapse （POP）, and investigate the relationship of pelvic organ prolapse quantitation （POP-Q） stage and pubococcygeal line （PCL） for the patient with POP. Methods Twenty patients with POP were evaluated by POP-Q stage and pelvic dynamic MRI examination simultaneously. Sagittal MRI images were acquired at rest and during maximal Valsalva using a fast gradient echo sequence two-dimensional fast low angle shot （FLASH） T1weighted image. The degree of prolapsed anterior vaginal wall, uterus and posterior vaginal wall were measured by PCL and compared with POP-Q system. Results There were 20 cases with cystocel diagnosed by POP-Q staging system, in which bladder neck or bladder base of 17 patients were under the PCL during maximum Valsalva. The concordance rate was 85% （17/20） between PCL and POP-Q stage. There were 19cases with rectocele diagnosed by POP-Q, in which the anorectal junction of 4 patients＇ PCL descent below more than 2. 5 cm. The concordance rate was 4/19 between PCL and POP-Q stage. There were 14 cases with uterine prolapse diagnosed by POP-Q staging system, in which uterine cervix of all descent below PCL. The concordance rate was 14/14 between PCL and POP-Q stage. However, it was noted that 5 cases did not reach POP-Q staging and their lowest uteri cervix were below or above PCL but less than 1 cm at maximal Valsalva. Conclusions Compared with POP-Q staging system, the reference line of PCL determined by dynamic MRI could diagnose uterine prolapse accurately and anterior vaginal wall with greater clinical value,however it was limited in diagnosing posterior vaginal wall prolapse effectively. Therefore, the clinical value of PCL should be further studied for evaluating POP.

关 键 词：子宫脱垂 磁共振成像 骨盆测量 耻骨联合 

分 类 号：R686[医药卫生—骨科学]