静动态MRI对初产妇分娩前后盆底结构变化的评估  

Evaluation of the Changes of Pelvic Floor Structure Inprimipara Before and After Delivery by Static and Dynamic MRI

作　　者：张彩霞[1] 林晓南[1] 刘碧英[1] 兰鹏 张小镇 叶成斌[1] ZHANG Caixia;LIN Xiaonan;LIU Biying(Department of Radiology,the People’s Hospital of Fujian Traditional Chinese Medicine University,Fuzhou,Fujian Province 350005,P.R.China)

机构地区：[1]福建中医药大学附属人民医院医学影像科,350005

出　　处：《临床放射学杂志》2024年第11期1939-1944,共6页Journal of Clinical Radiology

基　　金：福建省科技厅基金资助项目(编号:2019Y0033)。

摘　　要：目的采用静动态MRI观察并评估初产妇产前及产后不同时间盆底结构变化情况。方法前瞻性选取符合纳入标准的初产妇志愿者,分别于产前、产后3个月、产后6个月行盆底静动态MRI检查,分析和测量静息期及力排期盆底结构的各项形态学指标,包括:膀胱颈至耻骨尾骨线(PCL)的距离(B-PCL)、子宫最下缘至耻骨尾骨线的距离(U-PCL)、耻骨联合下缘至直肠后壁肛管直肠交界部(ARJ)的距离(H线)、H线末端至耻骨尾骨线的垂线距离(M线)、肛提肌裂隙面积(LHA)、提肛板角(LPA),静息状态图像测量双侧肛提肌厚度(PRT)。两两比较产前及产后不同时间各参数分别在静态MRI和力排期MRI的差异。参照MRI诊断盆腔器官脱垂(POP)的标准及临床诊断压力性尿失禁(SUI)的标准将产后受试者分为盆底功能障碍性疾病(PFD)组和正常组,进一步比较两组在产前及产后不同时间的盆底各测量参数差异。结果两位医师测量的静息期及动态期各盆底指标一致性良好,ICC值均>0.75。受试者产前与产后3个月比较,静息态的M线、LPRT差异有统计学意义(P<0.05),其余静息态参数及力排期诸参数均无统计学意义;产前与产后6个月比较,静息态的M线、LPA有统计学意义(P<0.05),其余静息态参数及力排期诸参数均无统计学意义;产后3个月与产后6个月比较,静息态及力排期各参数均无统计学意义。产后PFD组与正常组比较:产前力排期的B-PCL、U-PCL、LHA差异有统计学意义(P<0.05),其余力排期参数及静息态诸测量参数均无统计学意义;产后3个月力排期的B-PCL、U-PCL、H线、M线、LHA、LPA差异均有统计学意义(P<0.05),静息态各参数的差异均无统计学意义;产后6个月力排期的B-PCL、U-PCL、M线及静息态的B-PCL差异有统计学意义(P<0.05),其余静息态及力排期各参数的差异均无统计学意义。结论盆底动静态MRI检查能全面评估盆底结构变化,并能早期发现Objective To observe and evaluate the changes of pelvic floor structure in primipara at different time before and after delivery by static and dynamic MRI.Methods Prospective selection of primipara volunteers was performed with static and dynamic MRI of the pelvic floor before,3 months after delivery and 6 months after delivery.The parameters or changes of pelvic floor structures were analyzed and measured during the rest and the strain state,including the distance between bladder neck to puboccygeal line(B-PCL),the distance between the lowest uterine margin to the puboccygeal line(U-PCL),the distance between the inferior margin of public symphysis to anorectal junction(ARJ)(H line).the perpendicular distance between the distal end of H line to puboccygeal line(M line),levator ani hiatal area(LHA),levator plate angle(LPA).Bilateral levator ani thickness(PRT)was measured on rest state.The difference of parameters at rest and strain state at different time before and after delivery was compared in pairs.Then the subjects were divided into PFD group and normal group according to the criteria of MRI diagnosis of POP and clinical diagnosis of SUI,compare the differences of the parameters of the pelvic floor between the two groups.Results The parameters of pelvic floor measured by the two doctors were in good agreement with each other during the rest and the strain state,and the ICC values were all higher than 0.75.There were significant differences in M line and LPRT at rest state between prenatal and postnatal 3 months(P<0.05).Between prenatal and postnatal 6 months,the M line and LPA at rest state were statistically significant(P<0.05).While the rest parameters were not statistically significant.There was no significant difference between the 3th month postpartum and the 6th month postpartum in all parameters.Compare the parameters between PFD group and normal group after delivery:There was a statistically significant difference(P<0.05)in the B-PCL,U-PCL,and LHA of prenatal at strain state(P<0.05).B-PCL,U-PCL,H-line

关 键 词：盆底 盆底功能障碍性疾病 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R711.5[医药卫生—诊断学]