静息状态下盆腔器官脱垂与非盆腔器官脱垂女性肛提肌MRI三维结构的对比  

Comparison of levator ani muscles in three-dimensional MRI-based models in women with and without pelvic organ prolapse at rest

作　　者：刘萍[1] 陈若兰[1] 陈春林[1] 陈兰[3] 彭程[1] 黄璐[1] 王建平[2] 谭欢庆[2] 廖科丹[1] 唐连 王月祉 唐雷[3] 钟世镇[3] 

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]南方医科大学南方医院影像科,广州510515 [3]南方医科大学解剖教研室

出　　处：《中华妇产科杂志》2015年第6期428-433,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金（61190120、61190122、81272585、81370726）;广东省自然科学基金（S2011010003830）

摘　　要：目的以MRI数据为基础构建盆腔器官脱垂（POP）患者及无POP症状妇女盆底肛提肌的三维结构，对比分析静息状态下POP患者肛提肌的结构特点。方法选取2012年9月至2015年1月就诊于南方医科大学南方医院的患者，经盆腔器官脱垂定量（POP-Q）分度法诊断为POP的中老年患者25例（POP组），非POP组为无POP症状的其他妇科疾病患者22例。采集盆腔MRI数据，利用计算机软件三维重建骨盆、盆腔器官及肛提肌的三维模型，对比两组肛提肌的形态变化并对肛提肌参数进行测量、分析。结果非POP组中耻骨直肠肌与耻骨联合下缘附着起始处均无断裂现象，POP组患者中仅左侧断裂者3例，仅右侧断裂者3例，7例双侧断裂。非POP组中髂骨尾骨肌形态均为穹隆状，POP组患者有11例为漏斗状。非POP组中肛提肌裂孔7例U形，12例V形，3例不规则形态；POP组患者中，5例U形，4例V形，16例不规则形态。相对于非POP组，POP组患者肛提肌裂孔前后径增大[分别为（61．6±7．2）、（68．0±8．9）mm，P〈0．05]、横径增大[分别为（38．0±3．2）、（41．4±3．9）mm，P〈0．05]；肛提肌距耻骨联合下缘距离均增大，左侧分别为（24．6±3．7）、（29．6±7．4）mm（P〈0．05），右侧分别为（23．9±3．2）、（28．4±6．8）mm（P〈0．05）；肛提肌板角度增大，分别为（40．6±6.3）。、（51．0±11-3）。（P〈0．05）；肛提肌体积略变小，分别为（24．6±5．0）、（23．7±5．8）cm。（P〉0．05）。结论静息状态下，以MRI数据为基础的肛提肌三维模型结构能够客观评估POP患者肛提肌的变化，可通过显示肛提肌的整体情况反映盆底功能。Objective Comparison of the levator ani muscles in three-dimensional （3D） MRI-based models in women with and without pelvic organ prolapse at rest to analyze the morphological characteristics of levator ani muscles in women with POP. Methods Twenty-five women with POP and 22 women with normal pelvic support were selected from Nanfang Hospital of Southern Medical University. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the women in the supine position.The 3D models were reconstructed from the source images. Morphological changes was compared within the two groups of levator ani muscles, and the 3D models were measured to determine the levator ani muscle volume （LVOL）, levator plate angle （LPA）, levator hiatus width （LH-W） and length （LH-L）, distance between symphysis and levator sling muscle （LSG）. Results There were no puborectalis avulsions in control, in POP, 3 cases of avulsions just in left, 3 cases of avulsions just in right, 7 cases in bilateral. The shape of iliococcygeus were all dome-shaped in control, 11 cases were U-shaped and 14 cases were dome-shaped in POP. The shape of levator hiatus were 7 cases of U-shape, 12 cases of V-shape, 3 cases of irregular in control; 5 cases of U-shape, 4 cases of V-shape, 16 cases of irregular in POP. POP versus control： LH-L： （68.0±8.9） versus （61.6±7.2） mm （/9〈0.05）; LH-W： （41.4±3.9） versus （38.0±3.2） mm （P〈 0.05）; LSG-L： （29.6±7.4） versus （24.6±3.7） mm （P〈0.05）; LSG-R： （28.4±6.8） versus （23.9±3.2） mm （P〈 0.05）; LPA： （51.0± 11.3）° versus （40.6±6.3）°（P〈0.05）; LVOL： （23.7±5.8） versus （24.6±5.0） cm3 （P〉0.05）. Conclusions It is possible to assess the morphologic changes of levator ani by using 3D MRI models objectively, our 3D data demonstrate larger in LVOL, LPA, LH-W, LH-L, LSG, and the changes in shape. It is helpful to diagnose and assess the specific situation of patients POP in clinic.

关 键 词：盆腔器官脱垂 肌 骨骼 骨盆 磁共振成像 成像 三维 

分 类 号：R711.2[医药卫生—妇产科学]