静动态MRI测量肛提肌裂孔面积预测女性盆底功能障碍的价值研究

A study on the value of static and dynamic MRI to measure levator hiatus area to predict female pelvic floor dysfunction

目的探讨静动态磁共振成像(MRI)测量肛提肌裂孔面积(LHA)预测女性盆底功能障碍(PFD)的价值。方法选取60例女性盆底功能障碍患者作为观察组,另选取38例女性健康志愿者作为对照组。两组均接受MRI静、动态扫描。比较两组静动态扫描的肛提肌裂孔面积、裂孔左右径、裂孔前后径。结果观察组中压力性尿失禁31例,盆腔器官脱垂16例,盆腔器官脱垂合并压力性尿失禁13例,其中膀胱膨出25例,子宫脱垂14例,直肠膨出6例,直肠全层套叠1例、直肠黏膜套叠2例,道格拉斯窝疝出2例,疝出内容物均为腹膜脂肪。观察组中,静动态MRI提示肛提肌损伤49例,占比81.7%。观察组动态状态下的肛提肌裂孔面积(30.91±11.57)cm^(2)、裂孔前后径(6.81±1.25)cm、裂孔左右径(5.54±1.49)cm均大于对照组的(19.16±4.41)cm^(2)、(5.59±0.82)cm、(4.34±0.63)cm,差异具有统计学意义(P<0.05)。两组静息状态下的肛提肌裂孔面积、裂孔前后径、裂孔左右径比较,差异无统计学意义(P>0.05)。结论盆底功能障碍患者肛提肌裂孔面积增大,静动态MRI测量肛提肌裂孔面积可以预测盆底功能障碍,可以作为排除性指标,肛提肌裂孔面积、裂孔左右径、裂孔前后径增大,提示肛提肌受损、退变。

Objective To discuss the value of static and dynamic magnetic resonance imaging(MRI)to measure levator hiatus area(LHA)to predict female pelvic floor dysfunction(PFD).Methods 60 female patients with pelvic floor dysfunction were selected as the observation group,and another 38 female healthy volunteers were selected as the control group.Both groups received static and dynamic MRI scanning to compared the levator hiatus area,left and right diameters of levator ani hiatus,front and rear diameter of levator ani hiatus between the two groups.Results In the observation group,there were 31 cases of stress urinary incontinence,16 cases of pelvic organ prolapse,13 cases of pelvic organ prolapse combined with stress urinary incontinence,including 25 cases of cystocele,14 cases of uterine prolapse,6 cases of proctocele,1 case of full-thickness rectal intussusception,2 cases of rectal mucosa intussusception,2 cases of Douglas fossa hernia,and the contents of hernia were all peritoneal fat.In the observation group,static dynamic MRI suggested injury of levator ani muscle in 49 cases,accounting for 81.7%.The levator hiatus area,left and right diameters of levator ani hiatus,front and rear diameter of levator ani hiatus in the dynamic state were(30.91±11.57)cm^(2),(6.81±1.25)cm,and(5.54±1.49)cm in the observation group,which were all larger than those of(19.16±4.41)cm^(2),(5.59±0.82)cm,and(4.34±0.63)cm in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in levator hiatus area,left and right diameters of levator ani hiatus,front and rear diameter of levator ani hiatus in the static state between the two groups(P>0.05).Conclusion The levator hiatus area increased in patients with pelvic floor dysfunction.Static and dynamic MRI scanning can predict pelvic floor dysfunction,and can be used as an exclusive indicator.The increase of levator hiatus area,left and right diameters of levator ani hiatus,front and rear diameter of levator ani hiatus indicates that levator ani is damaged and degenerated.