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MRI在产后盆底功能 障碍早期评估中的 应用

作者:李 筠1 杨文生1 罗 武2

所属单位:1.广东药科大学附属第一医院妇产 科 (广东 广州 510080) 2.广东药科大学附属第一医院影像 科 (广东 广州 510080)

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摘要

目的 探讨磁共振成像(MRI)在产 后盆底功能障碍早期评估中的应用。方 法 选择医院2016年3月-2018年3月收治的 产后盆底功能障碍产妇80例作为观察组, 另选择同时期产后盆底功能正常的产妇80 例作为对照组,两组均接受MRI扫描,对 比两组产妇静态和动态下影像特点。结 果 在MRI扫描静态和动态下,观察组的髂 骨尾骨肌、耻骨尾骨肌、耻骨直肠肌面积 均小于对照组(P<0.05)。观察组的横断 位肛提肌裂孔宽度、矢状位耻骨联合到肛 直肠连接后缘的连线(LH线)、直肠后壁耻 骨直肠肌附着点到耻骨联合下缘到末端尾 椎1-2间隙的连线的垂线(M线)长度、肛 提肌角度(LPA)及髂骨尾骨肌角度(ICA) 均明显大于对照组(P<0.05)。观察组的 髂骨尾骨肌厚度(ICT)明显小于对照组(P <0.05)。结论 MRI可显示出产妇产后早 期的盆底功能及形态变化,对产后盆底功 能障碍的早期评估有重要的作用。

Objective To explore the application of magnetic resonance imaging (MRI) in the early evaluation of postpartum pelvic floor dysfunction. Methods A total of 80 cases of patients with postpartum pelvic floor dysfunction who were admitted to the hospital from March 2016 to March 2018 were selected as observation group. Another 80 cases of women with normal postpartum pelvic floor function at the same period were selected as control group. The two groups were given MRI scan. The results of transverse, sagittal and coronal images at static state and dynamic state were compared between the two groups. Results Under the static and dynamic MRI scans, the areas of illiococcygeous, pubococcygeous and puborectalis in observation group were smaller than those in control group (P<0.05). In observation group, the width of transverse levator ani fissure, LH line (the link of sagittal pubic symphysis to posterior border of anorectal junction), M line ( the perpendicular distance between right rectal posterior puborectal muscle attachment point to the link of lower edge of pubic symphysis and the 1-2 gap of terminal caudal vertebra), levator plate angle (LPA) and iliococcygeal angle (ICA) were significantly greater than those in control group (P<0.05). The iliac coccygeal muscle thickness (ICT) in observation group was significantly lower than that in control group (P<0.05). Conclusion MRI can show the pelvic floor function and morphological changes in early postpartum period, and it plays an important role in the early evaluation of postpartum pelvic floor dysfunction.

【关键词】盆底功能障碍;产后;早期; 磁共振成像

【中图分类号】R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.01.034

前言

盆底功能障碍是由于分娩、年龄增大及长期便秘等使盆底肌肉松 弛或缺陷,导致盆腔脏器功能发生改变,主要包括盆腔器官脱垂和 压力性尿失禁,在产后女性十分常见。以往主要凭借临床症状进行诊 断,缺乏客观影像学诊断依据。近年来,由于磁共振成像(MRI)可清 晰显示出盆底纤维结缔组织及盆腔结构,分辨率很高,临床上作为一 种无创性检查手段得到广泛应用。大量临床研究证实,MRI对产后盆 底功能障碍的检测具有重要的诊断价值[1-2]。本研究通过对比2016年3 月-2018年3月收治的产后盆底功能障碍产妇及同时期产后盆底功能正 常的产妇的盆底MR影像差异,探讨MRI在产后盆底功能障碍早期评估的 临床价值,旨在为临床诊断早期盆底功能障碍提供有效依据。现报道 如下。