MRI评估宫颈癌子宫根治术后患者肛提肌长期变化  

MRI for evaluation on long-term changes of levator ani muscle in cervical cancer patients after radical hysterectomy

作　　者：卢逸嘉 陈春林[1] 刘云鹭 黄璐[1] 冯婕[2] 刘萍[1] LU Yijia;CHEN Chunlin;LIU Yunlu;HUANG Lu;FENG Jie;LIU Ping(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Imaging,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,广东广州510515 [2]南方医科大学南方医院影像科,广东广州510515

出　　处：《中国医学影像技术》2022年第8期1213-1217,共5页Chinese Journal of Medical Imaging Technology

基　　金：南方医科大学南方医院临床研究专项(2018CR030)。

摘　　要：目的采用MRI评估宫颈癌子宫根治术(RH)后1、5年患者肛提肌变化。方法前瞻性纳入30例接受RH的宫颈癌患者,分别于术前、术后1年及5年采集静息态及最大瓦尔萨尔瓦动作下盆底MRI,重建骨盆及肛提肌三维模型;测量并比较不同时间点肛提肌裂孔横径(LH-W)、前后径(LH-L)、肛提肌板角度(LPA)、肛提肌体积(LVOL),双侧肛提肌与耻骨联合下缘间距(LSG)、髂尾肌角度(ICA)及厚度(ICT)、耻骨直肠肌厚度、M线及H线长度的差异。结果静息态及最大瓦尔萨尔瓦动作下,双侧ICT及耻骨直肠肌厚度逐渐变薄、M线逐渐延长,各时间点差异均有统计学意义(P均<0.05)。术后1年,静息态下LVOL较术前减小(P<0.05);最大瓦尔萨尔瓦动作下,双侧ICA及LPA均较术前增大而LVOL减小(P均<0.05)。结论宫颈癌RH术后患者髂尾肌、耻骨直肠肌逐渐萎缩变薄,盆底支持能力逐渐减弱。Objective To observe changes of levator ani muscle in cervical cancer patients 1 year and 5 years after radical hysterectomy(RH)with MRI.Methods Totally 30 cervical cancer patients after RH were prospectively enrolled.MR images of pelvic floor under resting-state and the maximum Valsalva maneuver were acquired before,1 year and 5 years after RH,respectively,and three-dimensional models of pelvis and levator ani muscle were reconstructed.The width of levator hiatal(LH-W),length of levator hiatal(LH-L),levator plate angle(LPA),levator volume(LVOL),as well as the distance between symphysis and levator sling muscle(LSG),iliococcygeus angle(ICA),left/right iliococcygeus thickness(ICT),thickness of puborectalis,the length of M-line and H-line were measured and compared among different time points.Results Under resting-state and the maximum Valsalva maneuver,bilateral ICT and the thickness of puborectalis gradually became thinner,and the M-line gradually lengthened,and significant differences were found among all time points(all P<0.05).One year after RH,under resting-state,LVOL decreased 1 year compared with preoperative(P<0.05),while under the maximum Valsalva maneuver,bilateral ICA and LPA increased furtherly and LVOL decreased(all P<0.05).Conclusion The iliococcygeus and puborectalis gradually atrophied and thinned in cervical cancer patients after RH,while the pelvic floor support ability gradually became weakened.

关 键 词：子宫颈肿瘤 子宫切除术 肛提肌 磁共振成像 前瞻性研究 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]