盆腔器官脱垂盆腔器官及肛提肌动态三维模型构建方法研究  

Study on the construction method of dynamic three-dimensional model in vivo of pelvic organs and levator ani muscle in POP

作　　者：刘萍[1] 唐连 陈春林[1] 陈兰[1] 谭欢庆[2] 苍鹏[2] 林艳 李晓玲 廖科丹[1] 彭程[1] 黄璐[1] 王月祉 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南方医科大学南方医院影像科,广东广州510515 [3]广东燕岭医院妇科,广东广州510507

出　　处：《中国实用妇科与产科杂志》2016年第4期341-346,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81370736;81571422);南方医科大学南方医院院长基金(2012Z010);南方医科大学南方医院院级教育基金(14NJ-MS06)

摘　　要：目的探讨利用动态磁共振成像(magnetic resonance imaging,MRI)原始数据集构建盆腔器官脱垂(pelvic organ prolapse,POP)盆腔器官及肛提肌动态三维模型的方法及意义。方法选取1例于2014年10月在南方医科大学南方医院行盆腔动态MRI扫描的POP患者,利用计算机三维重建软件构建静息及最大脱垂状态骨盆、盆腔器官及肛提肌三维模型,并对其进行三维测量,包括:肛提肌板角度,肛提肌裂孔横径及前后径;膀胱颈、宫颈内口、肛管直肠连接处距耻尾线(pubococcygeal line,PCL)的投影距离。结果 (1)最大脱垂状态时膀胱失去正常形态,从阴道前壁向前下脱出;阴道前壁呈凹槽状,子宫从后下脱入阴道内;肛直肠向后下移位。(2)最大脱垂状态与静息状态相比,肛提肌板角度增大15.25°,肛提肌裂孔横径增大5.88 mm,肛提肌裂孔前后径增大16 mm。盆腔器官垂直方向下移:膀胱:43.46 mm,子宫:46.48 mm,直肠:18.91 mm。结论 POP盆腔器官及肛提肌动态三维模型可以再现POP患者达最大脱垂程度时盆腔结构的真实状态,是对静息盆腔器官及肛提肌数字化三维模型的重要补充,有望为盆底手术提供个体化的解剖学和功能学参考。Objective To explore the method and significance of constructing dynamic three-dimensional model of pel- vic organs and levator ani muscle in female pelvic organ prolapse patient based on dynamic magnetic resonance imaging. Methods One female patient diagnosed with pelvic organ prolapse was chosen, who undertook dynamic magnetic reso- nance imaging scanning in Nanfang Hospital of Southern Medical University in Oct 2014,and 3D reconstruction software was used to reconstruct and align the three dimensional pelvic bone,pelvic organs and levator ani muscle in resting and maximum prolapse state; 3D measurement tools were adopted to measure following indicators ： the levator plate angle, le- vator hiatus width and length, bladder neck,cervical and anorectal junction vertical projection distance from PCL（pubo- coccygeal line）.Results （1）At the maximum prolapse state,bladder lost its normal shape,prolapsing from the anterior vaginal wall; the anterior vaginal wall was groove-shaped; uterus prolapsed into the vagina, uterus and rectum all moved back and down. （2）Compared with resting state, at the maximum prolapse state, l evator plate angle increased by 15.25%, levator hiatus width increased by 5.88 mm and levator hiatus length increased by 16 mm; pelvic organs moved down： bladder： 43.46 mm,uterus ： 46.48 mm, rectum：18.91 mm.Conelusions Dynamic three-dimensional model of pelvic or- gan and levator ani muscle in FPOP can reproduce the true state of pelvic structures when patient reached maximum degree ofprolapse,which is an important complement to thesim- ple resting three-dimensional model;moreover, it may pro- vide individualized anatomical and functional reference for pelvic floor surgery.

关 键 词：动态磁共振成像 肛提肌 盆腔器官 三维重建 三维测量 

分 类 号：R711.2[医药卫生—妇产科学]