直肠内注入模拟粪便的动态MRI对女性盆底痉挛综合征的诊断价值

Value of dynamic MRI with rectum injection in the diagnosis of female spastic pelvic floor syndrome

目的 利用动态MRI研究直肠内模拟粪便注入前、后女性盆底痉挛综合征（SPFS）患者的肛直肠形态、功能性病变,并对多盆腔器官脱垂进行评价,明确注入球囊后的动态MRI在SPFS患者中的诊断优势。方法 对53例临床诊断为SPFS的女性患者行动态MRI检查,使用自行设计高顺应性球囊模拟大便,测量患者直肠内球囊注入前、后力排相盆底的相关数据。结果 盆底动态MRI结果显示,53例女性SPFS患者中,伴发多盆腔器官脱垂者24例。直肠内造影剂注入前、后力排相的肛直角变化,差异无统计学意义（χ^2=0.603,P 〉 0.05）;相比直肠内模拟粪便注入后的盆底动态MRI,未注入的力排相分别有18.0%（9/50）膀胱脱垂、6.1%（3/49）子宫或阴道穹窿脱垂、32.7%（17/52）直肠前膨出及14.6%（7/48）会阴体下降诊断为阴性。直肠内模拟粪便注入前、后力排相观察多盆腔器官脱垂变化,差异均有明显统计学意义。结论 直肠内注入模拟粪便的盆底动态MRI为女性SPFS患者提供了更全面的诊断,为术前正确诊断盆腔多部位缺陷及术后正确评价治疗效果提供了客观依据。

Objective Dynamic MRI with rectum injectionis employed to assess female spastic pelvic floor syndrome of anorectal morphology and function in relation to various pelvic compartment abnormalitiesin female outlet obstruction constipation. Methods Dynamic MRI was performed in 53 female patients（14-78 years of age, with a mean age of 52.7±15.8 years）with clinical diagnosis of spastic pelvic floor syndrome.The homemade highly conformable sacculus was inserted into the rectum to simulate stool. The relevant measurements were then obtained during straining before and after rectum injection. Results Among the 53 female patients with spastic pelvic floor syndrome, 24 patients（45.3%） have multifocal disorders involving more than one compartment.The difference in the anorectal angles before and after rectum injection was not significant（χ^2=0.603,P 〉 0.05）. Differences in the cystocele, vaginal or cervical prolapse, rectocele, and descending perineum before and after rectum injection were significant. Conclusion Using dynamic MRI with rectum injection allows for the accurate evaluation of the anorectal morphology and function related to various pelvic compartment abnormalitiesin female spastic pelvic floor syndrome; thus, this method is proved valuable in the diagnosis and treatment of female spastic pelvic floor syndrome.