盆腔器官脱垂患者宫骶韧带与输尿管、直肠解剖关系的MRI三维重建研究  

Three-dimensional MRI reconstruction research on the anatomical relationship among uterosacral ligament and ureter or rectum in pelvic organ prolapse patients

作　　者：梁诗琪 陈春林[1] 刘萍[1] 唐连 黄璐[1] 姜文轩 黎依文 Liang Shiqi;Chen Chunlin;Liu Ping;Tang Lian;Huang Lu;Jiang Wenxuan;Li Yiwen(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Radiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

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

出　　处：《中华妇产科杂志》2021年第1期27-33,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81571422);南方医科大学南方医院临床研究专项(2018CR030);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD019)。

摘　　要：目的采用MRI三维重建模型研究盆腔器官脱垂(POP)患者宫骶韧带与输尿管、直肠的解剖关系。方法按照研究标准纳入2015年5月至2020年3月就诊于南方医科大学南方医院并行手术前盆腔MRI检查的POP患者67例;以中盆腔Ⅰ~Ⅱ度脱垂为轻度POP(37例),中盆腔Ⅲ~Ⅳ度脱垂为重度POP(30例)。三维重建形成三维模型,并在宫骶韧带的拟合曲线与坐骨棘连线平面的交点标记为P0点,向骶骨方向每增加1 cm分别标记P1、P2、P3点;分别在P0~P3点水平测量直肠和输尿管到宫骶韧带的最短距离。结果(1)左侧输尿管到左侧宫骶韧带的距离为(15.45±7.46)~(19.31±11.38)mm,右侧输尿管到右侧宫骶韧带的距离为(13.77±8.16)~(14.78±9.18)mm;P1点水平输尿管距离宫骶韧带最近,重度POP患者右侧输尿管在P2点水平距离右侧宫骶韧带最近,为(13.45±9.34)mm;双侧输尿管距离同侧宫骶韧带的最远距离均位于P3点水平。(2)直肠在P0点水平距离双侧宫骶韧带最近,左侧为(20.62±9.99)mm,右侧为(16.82±9.63)mm,左右两侧比较,差异有统计学意义(P=0.026);直肠与右侧宫骶韧带更靠近;轻度POP患者直肠到双侧宫骶韧带的距离在各标记点均无差异(P均>0.05),重度POP患者直肠更靠近右侧宫骶韧带,最近在P0点水平为(15.64±10.31)mm。结论与左侧宫骶韧带相比,输尿管和直肠与右侧宫骶韧带的关系更密切,POP患者在行右侧宫骶韧带手术操作时需更注意勿损伤输尿管和直肠。Objective To study the anatomical relationship among uterosacral ligament and ureter or rectum by using MRI three-dimensional reconstruction model in pelvic organ prolapse(POP)patients.Methods According to the research standard,67 POP patients were enrolled,who accepted pelvic MRI before surgery in Nanfang Hospital,Southern Medical University during May 2015 to March 2020.Three-dimensional model of uterosacral ligament was reconstructed.The intersection point of the fitting curve of uterosacral ligament and ischial spine level marked point P0,every 1 cm increasing from P0 towards the sacrum marked points P1,P2,and P3.Distances were measured between rectum or ureter to uterosacral ligament respectively at the P0-P3 horizontal levels.Results(1)The distances between the left ureter and the left uterosacral ligament were(15.45±7.46)to(19.31±11.38)mm,and the distances between the right ureter and the right uterosacral ligament were(13.77±8.16)to(14.78±9.18)mm.At the P1 horizontal level ureters were the closest to uterosacral ligaments,and the right ureter was the closest to right uterosacral ligament[(13.45±9.34)mm]at P2 horizontal level in severe POP group.The farthest distance presented at the P3 horizontal level between bilateral ureters and uterosacral ligaments.(2)At the P0 horizontal level,the rectum was the closest to the bilateral uterosacral ligaments[left:(20.62±9.99)mm,right:(16.82±9.63)mm;P=0.026],and the rectum was closer to the right uterosacral ligament.There were no significant differences in the distance between rectum and bilateral uterosacral ligaments in mild POP group(P>0.05),and the results of severe POP group also showed the rectum was closer to the right uterosacral ligament[(15.64±10.31)mm at P0 horizontal level].Conclusions Right ureter and rectum are closer to the right uterosacral ligament.Gynecologists should pay more attention to avoid damaging the right ureter and rectum during the operation of the right uterosacral ligament in POP patients.

关 键 词：盆腔器官脱垂 子宫 韧带 输尿管 直肠 磁共振成像 成像 三维 宫骶韧带 

分 类 号：R711.5[医药卫生—妇产科学]