磁共振对难治性排便障碍型便秘患者盆底裂孔改变的研究

MRI study of pelvic floor hiatus in patients with intractable defecation constipation

目的探讨磁共振下难治性排便障碍型便秘患者在静息和力排期盆底裂孔的改变。方法前瞻性选取山东第一医科大学附属第一医院收治的难治性排便障碍型便秘患者60例(观察组),并同期招募37名健康志愿者(对照组)。分别对两组研究对象在静息和力排期进行盆底磁共振扫描检查,比较两组盆底裂孔的横径(LH-W)、纵径(LH-L)、盆底裂孔后角的大小(LH-PA)、盆底裂孔纵轴偏离中心位置的距离(d-LHVC)。结果观察组与对照组在静息状态下盆底裂孔的横径(LH-W)、纵径(LH-L)分别为[(2.64±1.89)cm、(2.59±2.44)cm;(7.35±2.52)cm、(6.82±2.07)cm],两者比较差异无统计学意义(t=0.763,0.39;P>0.05);观察组与对照组在力排状态盆底裂孔的横径(LH-W)、纵径(LH-L)分别为[(3.37±2.26)cm、(4.11±3.84)cm;(6.64±2.29)cm、(5.54±1.84)cm],两者比较差异有统计学意义(t=-6.11,9.71;P<0.05)。观察组与对照组在静息状态下盆底裂孔后角(LH-PA)分别为[(48.57±5.23)°、(45.12±6.28)°],两者比较差异无统计学意义(t=2.58,P>0.05)。观察组与对照组在力排状态下盆底裂孔后角(LH-PA)分别为[(54.31±7.29)°、(68.84±6.37)°],两者比较差异有统计学意义(t=26.35,P<0.05)。观察组与对照组在静息状态下,d-LHVC分别为[(8.74±2.21)mm、(5.45±1.87)mm],两者比较差异有统计学意义(t=16.24,P<0.05);观察组与对照组在力排状态下,盆底裂孔纵轴偏离中心位置的距离(dLHVC)分别为[(12.31±2.32)mm、(6.47±2.16)mm],两者比较差异有统计学意义(t=-11.36,P<0.05)。结论难治性排便障碍型便秘患者在静息状态下即存在盆底裂孔中轴偏移,力排状态下盆底裂孔横径、后角较正常人变小,且盆底裂孔中轴发生偏移幅度较正常人明显增大,盆底裂孔形态存在明显不对称改变。

Objective To investigate the changes of pelvic floor hiatus in patients with refractory dysdefecation constipation under magnetic resonance imaging(MRI).Methods Sixty patients with refractory dysdefecation constipation(observation group)and 37 healthy volunteers(control group)were selected prospectively in the First Affiliated Hospital of Shandong First Medical University.The transverse diameter(LH-W),longitudinal diameter(LH-L),posterior angle of pelvic floor hiatus(LH-PA),and the distance of longitudinal axis of pelvic floor hiatus from the center(d-LHVC)were compared between the two groups.Results The transverse diameter(LH-W)and longitudinal diameter(LH-L)of the pelvic floor hiatus in the observation group and the control group were respectively[(2.64±1.89)cm,(2.59±2.44)cm;(7.35±2.52)cm,(6.82±2.07)cm],and there was no significant difference between the two groups(t=0.763,0.39;P>0.05).The transverse diameter(LH-W)and longitudinal diameter(LH-L)of the pelvic floor hiatus in the observation group and the control group were respectively[(3.37±2.26)cm,(4.11±3.84)cm;(6.64±2.29)cm,(5.54±1.84)cm],and the differences were statistically significant(t=-6.11,9.71;P<0.05).The posterior angle of pelvic floor hiatus(LH-PA)in the observation group and the control group were(48.57±5.23)°,(45.12±6.28)°,respectively,and there was no significant difference between the two groups(t=2.58,P>0.05).The posterior angle of pelvic floor hiatus(LH-PA)in the observation group and the control group were(54.31±7.29)°,(68.84±6.37)°,respectively,with statistical difference(t=26.35,P<0.05).In the resting state,the distance(d-LHVC)of the longitudinal axis of the pelvic floor hiatus was(8.74±2.21)mm and(5.45±1.87)mm respectively in the observation group and the control group,and the difference was statistically significant(t=16.24,P<0.05),The distance(d-LHVC)of the longitudinal axis of the pelvic floor hiatus was(12.31±2.32)mm and(6.47±2.16)mm respectively in the observation group and the control group,and the difference was statistically significant(t=-11.36,P<0.05).Conclusion The patients with refractory dysdefecation constipation have the central axis deviation of pelvic floor hiatus in resting state.The transverse diameter and posterior angle of pelvic floor hiatus are smaller than those of normal people under forced defecation state,and the deviation amplitude of pelvic floor hiatus axis is significantly larger than that of normal people,and the shape of pelvic floor hiatus is significantly asymmetric.