盆腔器官脱垂盆腔器官静动态磁共振成像三维变化特点研究

3D changes of static and dynamic pelvic organs of POP patients based on MRI

目的探讨盆腔器官脱垂(POP)盆腔器官静动态MRI三维变化特点。方法选取2014年9月至2017年4月就诊于南方医科大学南方医院、经POP-Q诊断为POPⅡ~Ⅳ度的患者30例(以前中盆腔脱垂为主,POP组);同期收集无POP症状的中年经产妇20例作为对照组。均行盆腔静动态MRI检查,利用Mimics 10.01进行三维模型的构建,并测量两组骨盆参考线长度及静动态器官指示点(膀胱颈、宫颈内口、肛直肠连接处)分别至耻尾线(PCL)头尾侧、耻棘线(PIS)内外侧、坐骨棘连线(IS)腹背侧的投影距离,对比两组盆腔器官自身静动态位置变化及组间盆腔器官上下、左右、前后方向移动度。结果 POP组26例与对照组20例成功重建。POP组动态(屏气用力)时盆腔器官脱垂程度明显大于静息,且发现2例POP患者合并肠疝;对照组动态较静息盆腔器官下移约10 mm。两组动态较静息PCL线均增大,但两组间骨盆参考线长度差异均无统计学意义。屏气用力前后两组间膀胱、子宫下移度差异有统计学意义(P<0.05);直肠下移度差异无统计学意义(P>0.05)。两组膀胱、子宫、直肠左右方向移动度均极小,约1~3mm;POP组膀胱未脱出阴道口时膀胱后移,膀胱脱出阴道口后膀胱前移;对照组膀胱均后移约10 mm,两组膀胱前后方向移动度差异有统计学意义(P<0.05),子宫、直肠后移度差异无统计学意义(P>0.05)。结论无论有无POP,屏气用力均使盆腔器官向下、向后移动。无POP时动态器官较静息平均下移、后移约10 mm;POP时器官下移度与其临床脱垂程度有关(平均下移度约30 mm),POP子宫、直肠后移度与对照组相当,膀胱脱垂为主时膀胱前移。

Objective To analyze the MRI three-dimensional changes of the static and dynamic pelvic organs in POP patients.Methods From September 2014 to April 2017 in Nanfang Hospital of Southern Medical University, according to POP-Q, 30 eases of POP elderly patients （anterior and middle prolapse mainly）are selected, middle-aged paramative female （without POP symptoms） has been collected during the same period as a control group （20 cases）.All of them underwent pelvic dynamic MRI examination, 3D model reconstructed by Mimics 10.01 ; measure the static and dynamic projection distance of bladder neck, inner cervix, anal rectum connection respectively to PCL line, PIS line, IS line in the two groups ; compare the movement of pelvic organs before and after Valsalva maneuver in the direction of front and back, left and right, up and down. Results Twenty-six patients with POP and the control group successfully finished the Valsalva maneuver with successful reconstruction.In POP group, the prolapse degree were more severe at Valsalva maneuver than at rest state, and 2 cases of POP patients with enterocele were found at Valsalva maneuver. Compared with rest state, the PCL line of two groups was longer at Valsalva maneuver, but the two groups had no statistically significant difference in PCL line.Bladder, uterus and rectum had downward movement in both groups, and the two groups had statistically significant difference in the downward movement of bladder and uterus （P 〈 0.05）, while rectal downward movement had no significant difference （P 〉 0.05）.Movement in the left and right direction of two groups was extremely small, about 1-3mm, with no clinical significance.ln POP, the moving direction of bladder was not consistent： when bladder prolapse was prominent, bladder moved forward, but when it was not, the bladder move d backward; two groups had statistically significant difference in the movement of bladder in the direction of back and forth （P〈O.05） , while uterus and rectum backward movement was not significantly different （P〉0.05）.Conclusion With or without POP, the pelvic organs will move downward and backward after the Valsalva maneuver. Without POP, pelvic organs averagedly moves downward and backward about 10 mm. In POP group, the downward movement is related to clinical prolapse degree（mean downward movement about 30 mm） ;the uterus and rectum backward movement in POP group is similar with paramative female （without POP symptoms） ;when bladder prolapse is prominent, bladder will move forward.