孕晚期女性肛提肌及邻近结构磁共振三维结构变化研究  

Changes of levator ani muscle and the adjacent structures in three-dimensional MRI of asymptomatic late pregnancy women

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

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

出　　处：《中国实用妇科与产科杂志》2016年第5期460-463,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨妊娠晚期正常妇女肛提肌三维模型特点。方法选取2013年11月至2015年3月就诊于南方医科大学南方医院行常规产检的孕晚期初孕妇27例，均为单胎、头位，孕30～40周，宫高、腹围检查均在正常范围，孕前及孕期均无盆腔器官脱垂（POP）及压力性尿失禁（SUI）症状。对照组为无SUI、POP临床症状的未育健康青年妇女志愿者25例。运用磁共振（MRI）三维重建技术构建妊娠晚期及正常妇女肛提肌三维模型，对比两组阴道形态、肛提肌裂孔形态变化，肛提肌参数以及膀胱颈、宫颈和肛直肠连接处到耻尾线（PCL）的距离。结果对照组中肛提肌裂孔均为“V”形，孕妇组肛提肌裂孔22例“V”形，5例“U”形，孕妇组肛提肌裂孔前后径较对照组增大[LH-L，（60．01±6．63）mm VS．（54．03±5．09）mm，P〈0．01]，横径增大[LH-W，（36．61±3．58）mm vs．（32．58±4．09）mm，P〈0．01]，耻骨直肠肌两侧距耻骨联合下缘距离增大（左侧LSG-L（23．19±3．42）mm VS．（18．79±2．52）mm，P〈0．01；右侧LSG-R（22．10±3．58）mm vs．（18．34±2．50）mm，P〈0．01]，肛提肌板角度增大[LPA（49．93±4.38）°VS．（42．94±4．38）°P〈0．01]，肛提肌体积变小LVOL（24．57±5．76）cm3 VS．（33．91±6．28）cm2，P〈0．01]．邻近结构阴道形态发生变化，对照组阴道形态均为“H”形，孕妇组21例“H”形，6例近“v”形，孕妇组器官到PCL的距离较对照组均变小（P〈0．05）。结论妊娠晚期妇女肛提肌结构发生重塑，趋向松弛改变，邻近阴道形态可发生变化，器官位置下移。Objective To analyse anatomical characteristics of the levator ani muscle in late pregnancy women based on three--dimensional MRI. Methods The cases were 27 asymptomatic late pregnancy women who were selected from November 2013 to March 2015 in Nanfang Hospital; all cases were head position, single fetus; pregnancy weeks were 30 ~ 40 weeks. The controls were 25 young nulliparous volunteers in Southern Medical University.Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained in the women in the supine position.The three- dimensional models were reconstructed from the source images.Morphological changes were compared within the two groups of levator ani and vagina, and the 3-dimensional 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） and the distance from the bladder neck, the cervix, the junction between rectum and anal to PCL. Results The shape of levator hiatus was all V- shape in control, 22 cases of V- shape and 5 cases of V-shape in pregnancy women, and the pregnancy women had larger LH-L, LH-W, LSG and LPA, smaller LVOL than control; the pregnancy women vs. the control： LH-L： （60.01 ±6.63）mm vs. （54.03±5.09）mm , P〈0.01; LH-W ： （ 36.61±3.58mm ） vs. （ 32.58±4.09 ） mm, P〈0.01; LSG- L（23.19±3.42）mm vs.（18.79±2.52）mm,P〈0.01 ; LSG-R （22.10±3.58） rnm vs. （18.34±2.50） ram, P〈0.01; LPA： （49.93 ± 4.38）° vs. （42.94 ＋ 4.38）° , P〈0.01, LVOL：（24.57±5.76） cm3 vs. （33.91±6.28） cm3, P〈0.01.The vaginal shape changed in pregnancy women, some showed V- shaped, while the controls were all H-shape.The distance from organs to PCL was smaller in pregnancy women than controls, P 〈 0.05.Conelusion The levator ani muscle structure was remodeled in late pregnancy women, tending to be loose; the vaginal morphology changed, and the pelvic orga

关 键 词：孕晚期 盆底 磁共振 三维重建 

分 类 号：R71[医药卫生—妇产科学]