动态磁共振检查观察压力性尿失禁患者盆底结构改变

目的 研究动态磁共振检查用于观察压力性尿失禁(SUI)患者盆底结构的改变,为临床诊治SUI及诊疗效果的评价提供更加全面可靠的依据.方法 随机选取50例尿失禁患者及50例健康女性作为对照组.通过磁共振观察静息及Valsalval动作(屏气)状态下两组肛提肌、尿道括约肌的形态及厚度的改变及尿道支持韧带(尿道周围韧带、尿道旁韧带、耻骨尿道韧带、尿道下韧带)的形态改变.结果 MRI检查示静息及屏气状态下SUI患者肛提肌形态失去正常"U"型结构,静息及屏气状态下肛提肌非"U"型占比分别为46%、73%,且不同状态下肛提肌形态改变差异有统计学意义(x^2=8.167,P=0.004);不同状态下,SUI组双侧肛提肌、尿道括约肌厚度较对照组变薄,且屏气状态下肛提肌厚度较静息态下薄,差异均有统计学意义(P<0.05),但对照组肛提肌、SUI组与对照组尿道括约肌厚度在不同状态下差异无统计学意义(P>0.05);SUI患者尿道周围支持韧带其中的一组或者多组韧带形态失常,呈松弛、扭曲或者断裂改变.结论 SUI组患者肛提肌及尿道支持韧带形态改变,肛提肌及尿道括约肌厚度变薄,对于临床诊治SUI患者,动态磁共振盆底检查能提供更精细更可靠的信息.

Objective To observe the changes of pelvic floor structure in patients with stress urinary incontinence by dynamic magnetic resonance imaging and provide a more comprehensive and reliable basis for clinical diagnosis and treatment of stress urinary incontinence and evaluation of the effect of diagnosis and treatment.Methods A total of 50 patients with urinary incontinence and 50 healthy women were randomly selected as the control group.The morphology and thickness of levator ani muscle and urethral sphincter,and the morphological changes of urethral supporting ligament(periurethral ligament,paraurethral ligament,pubourethral ligament and hypourethral ligament)were observed by magnetic resonance imaging(MKI).Results Compared with healthy women,patients with stress urinary incontinence under resting and breath-holding condition had abnormal"U"structure of puborectal muscle.The proportion of non-"U"type of puborectal muscle under resting and breath-holding condition were 46% and 73% respectively,and the morphological changes of puborectal muscle under different conditions had statistical significance(x^2=8.167,P=0.004).The thickness of puborectal muscle and urethral sphincter in the stress urinary inconrinence group was thinner than that in the control group at rest and breath holding,and the difference was statistically significant(P<0.05).The thickness of puborectal muscle in the stress unnary incontinence group had significant difierence at rest and breath holding(P<0.05),and also had the significant difference in the thickness of the puborectal muscle,which was lower than the resting state in the breath holding state.But there was no significant difference in the puborectalis muscle in control group between the state of resting and breath holding(P>0.05).Also,there was no significant difference in the thickness of urethral sphincter between the stress urinary incontinence group and the control group(P>0.05).One or more groups of ligaments surrounding the urethral support ligament were morphologically abrupt,distorted,or broken.Conclusion The morphology of puborectal muscle and urethral supporting ligament changes in different degrees,and the thickness of puborectal muscle and urethral sphincter become thinner in different degrees in patients with stress urinary incontinence.Magnetic resonance pelvic floor examination can provide more detailed and reliable information for clinical diagnosis and treatment in the patients with stress urinary incontinence.