基于MRI检查二维、三维重建图像的直肠脱垂女性患者盆底肛提肌形态解剖学观察  

MRI-based two-dimensional and three-dimensional reconstruction and morphological observation of levator ani muscle in female patients with rectal prolapse

作　　者：崔国策[1] 周娇娇[2] 李华山[2] CUI Guoce;ZHOU Jiaojiao;LI Huashan(Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 102618, China)

机构地区：[1]中国中医科学院广安门医院南区,北京102618 [2]中国中医科学院广安门医院

出　　处：《山东医药》2019年第12期22-26,共5页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81173275;81673988)

摘　　要：目的基于MRI检查二维、三维重建图像,观察直肠脱垂女性患者盆底肛提肌的形态解剖学变化。方法选取直肠脱垂女性患者14例为观察组,选取同期招募的15名健康女性志愿者为对照组。所有研究对象接受MRI检查,采集图像,观察MRI二维图像上肛提肌裂孔形态、髂尾肌形态、肛提肌损伤或断裂缺损情况。重建肛提肌的三维图像并测量相关参数:肛提肌裂孔宽度(LHW)、肛提肌裂孔长度(LHL)、左侧肛提肌与耻骨联合下缘间距(LSG-L)、右侧肛提肌与耻骨联合下缘间距(LSG-R)、肛提肌板角度(LPA)、肛提肌体积、左侧髂尾肌宽度、右侧髂尾肌宽度、左侧髂尾肌角度、右侧髂尾肌角度。结果①肛提肌裂孔形态:观察组8例为O形,3例为U形,3例为不规则形;对照组8例为V形且双侧对称,5例为O形,1例为U形,1例为不规则形。②髂尾肌形态:观察组3例为穹隆或圆顶状,2例形态接近水平状,9例形态接近漏斗状;对照组12例为穹隆或圆顶状,3例形态接近水平状。③肛提肌损伤或断裂缺损情况:观察组4例双侧均有损伤,6例肛提肌左侧损伤,4例肛提肌右侧损伤;对照组11例未发现肛提肌的断裂或缺损,2例肛提肌左侧损伤,2例肛提肌右侧损伤。④观察组LHW、LHL、LSG-L、LSG-R、LPA分别为(42. 33±3. 89) mm、(67. 41±7. 43) mm、(31. 11±5. 99) mm、(29. 36±5. 77) mm、50. 32°±8. 40°,对照组LHW、LHL、LSG-L、LSG-R、LPA分别为(35. 99±5. 21) mm、(58. 78±4. 21) mm、(23. 44±3. 78) mm、(24. 56±3. 75)mm、43. 48°±5. 82°,两组各对应参数相比,P均<0. 01。结论与健康女性相比,直肠脱垂女性患者盆底肛提肌各组成部分的形态发生了改变,出现了肌肉断裂缺损;肛提肌各组成部分的形态改变和肌肉断裂缺损是直肠脱垂发生的主要原因。Objective To observe the morphological features of levator ani muscle in patients with rectal prolapse through MRI-based two-dimensional and three-dimensional reconstruction. Methods Fourteen female patients with rectal prolapse( observation group) and 15 healthy women( control group) were selected,and they underwent routine MRI scanning and 3-dimensional T2 SPACE axis positioning sequence scanning. We analyzed the original data of levator hiatus shape,iliococcygeus form and damage or break defect on levator ani muscle,observed the morphological features of levator ani muscle,and measured the width,length of levator hiatus( LHW,LHL),left and right levator symphysis gap( LSG-L,LSG-R),levator plate angle( LPA),levator muscle volume( LVOL),width of the iliococcygeus( ICW-L,ICW-R) and left and right iliococcygeal angle( ICA-L,ICA-R). Results ① Levator hiatus shape: there were 8 cases of shape O,3 cases of U,and3 cases of irregular shape in the observation group;in the control group,there were 8 cases of shape V,5 cases of O,1 case of U,and 1 case of irregular shape.② Iliococcygeus form: in the observation group,3 cases were vaulted,2 cases were horizontal,9 cases seemed to be funnel-shaped;in the control group,12 cases were vaulted,and 3 cases were horizontal.③ Levator ani muscle injury or breakage: in the observation group,6 cases had the left side injury,4 cases had the right injury,4 cases had injuries of both sides;in the control group,2 cases had the left side injury,2 cases had the right injury,and 11 cases without injury.④ The LHW,LHL,LSG-L,LSG-R,and LPA of the observation group were( 42. 33 ± 3. 89) mm,( 67. 41 ±7. 43) mm,( 31. 11 ±5. 99) mm,( 29. 36 ±5. 77) mm,and 50. 32°±8. 40°,respectively;and the LHW,LHL,LSG-L,LSG-R,and LPA of the control group were( 35. 99 ± 5. 21) mm,( 58. 78 ± 4. 21) mm,( 23. 44 ± 3. 78) mm,( 24. 56 ±3. 75) mm,and 43. 48°±5. 82°,respectively;statistically significant differences were found between these the two groups( all P < 0. 01). Conclusions Compared with the

关 键 词：直肠脱垂 肛提肌 盆底 磁共振成像 

分 类 号：R657.1[医药卫生—外科学]