女性正常盆底与盆底脱垂性疾病MRI初步研究

MRI study of female normal pelvic floor and pelvic floor prolapsed disorders

目的 探讨用力排便时正常妇女与盆底脱垂性疾病患者盆腔器官位置和盆底形态变化特征。方法 选择女性健康志愿者 (对照组 )和盆底脱垂性疾病患者 (试验组 )各 60例进行盆腔动态MRI ,采用梯度回波二维FLASHT1加权快速扫描序列采集屏气期间静息和用力排便时盆腔横断、冠状和矢状面影像 ,观测盆腔器官的位置和盆底形态 ,比较盆腔在用力排便时对照组与试验组盆腔器官位置变化。结果 用力排便时试验组盆腔器官位置和盆底形态变化显著 ,与对照组比较膀胱颈下降 (P <0 .0 1)、子宫颈下降 (P <0 .0 1)、肛直肠连接下降 (P <0 .0 1)和盆膈裂孔膨胀 (P <0 .0 1)。试验组检出膀胱膨出 2 9例、子宫颈脱垂 3 6例、盆底疝 2 7例、直肠前突 11例和会阴下降综合征 3 9例。对照组仅发现 4例肛直肠连接过度下降和 3例轻度膀胱膨出。结论 盆腔动态MRI可用于准确评价用力排便时盆腔器官位置和盆底形态变化 。

Objective To explore the changes of pelvic visceral position and pelvic floor position during pelvic straining in normal women and female patients with pelvic floor prolapsed disorders. Methods Sixty asymptomatic women volunteers (control group) and 60 patients with pelvic floor prolapsed disorders (test group) underwent a pelvic dynamic MRI examination. Cross sectional, coronal and sagittal MR images were acquired at rest and during pelvic straining using a fast gradient echo sequence 2D FLASH T1WI. Changes of the pelvic visceral position and the pelvic floor position on the images were observed and compared in the test group and the control group. Results The changes of pelvic visceral position and pelvic floor position in the test group during pelvic straining were marked. Compared with those in the control group, significantly greater bladder neck descent ( P <0.01), uterocervical descent ( P <0.01), anorectal junction descent ( P <0.01), and pelvic diaphragm hiatus expanding ( P <0.01) were found in the test group. Twenty nine cases of cystocele, 36 cases of uterocervical prolapse, 27 cases of pelvic floor hernia, 11 cases of rectocele, and 39 cases of descending perineum syndrome were detected in the test group. Only 4 cases of anorectal junction excessive descent and 3 cases of slight cystocele were found in the control group. Conclusion Pelvic dynamic MRI may be used to evaluate accurately the changes of pelvic visceral position and pelvic floor position during pelvic straining. Multiple pelvic organs prolapse and pathological changes of the pelvic floor may often occur in patients with pelvic floor prolapsed disorders.