目的：通过MRI技术评估重度盆腔器官脱垂（POP）患者宫骶韧带和主韧带的形态结构，分析并探讨其临床意义。方法选择2013年11月至2014年2月在北京大学人民医院就诊的Ⅲ~Ⅳ度POP患者26例为POP组，选择同时期健康女性志愿者18例为对照组，对两组妇女行盆腔MRI检查，并建立MRI三维重建模型，细化描述并比较左、右侧宫骶韧带和主韧带在MRI上的形态学特征及其起止点附着部位。结果 POP组患者中，有25例左侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体[58%（15/26）]或尾骨肌[38%（10/26）]，止点位于子宫颈和阴道[58%（15/26）]或子宫颈[38%（10/26）]；有24例右侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体[31%（8/26）]或尾骨肌[62%（16/26）]，26例右侧宫骶韧带止点均位于子宫颈和阴道[62%（16/26）]或子宫颈[38%（10/26）]。两组妇女左、右侧主韧带均起自同侧骨盆侧壁坐骨大孔顶端的骶髂关节处。POP组患者中左侧主韧带止点1例（4%，1/26）完全与膀胱相连，10例（38%，10/26）部分与膀胱相连；右侧主韧带止点14例（54%，14/26）部分与膀胱相连；余左、右侧主韧带止点均位于子宫颈和（或）阴道。18例对照组妇女中有17例左侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体（10/18）或尾骨肌（7/18），止点均位于子宫颈和阴道（12/18）或子宫颈（6/18）；右侧宫骶韧带起点均位于骶棘韧带-尾骨肌复合体（10/18）或尾骨肌（8/18），止点均位于子宫颈和阴道（13/18）或子宫颈（5/18）；左侧主韧带有8例（8/18）部分与膀胱相连，右侧主韧带有15例（15/18）部分与膀胱相连，余左、右侧主韧带止点均位于子宫颈和（或）阴道。两组妇女宫骶韧带和主韧带左、右侧起止点分布分别比较，差异均无统计学意义（P>0.05）。结论 MRI对POP患者在体宫骶韧带和主韧带起止点、走行方向的观察与临床解剖一致。左、右侧宫骶韧带起止点及左、右侧主韧带止点均非完全对称，变异程度很大，部分主韧带可完全或部分与膀胱相连。%Objective To evaluate morphological structure of uterosacral ligament (USL) and cardinal ligament (CL) in patients with severe pelvic organ prolapse (POP) by MRI technology, and to analysis and discuss its clinical significance. Methods From November 2013 to February 2014 in Peking University People′s Hospital, 26 elderly patients withⅢ-Ⅳdegree of POP were selected as the POP group and 18 healthy elderly volunteers were selected as the control group during the same period. Pelvic MRI examination were performed in the two groups. The morphological characteristics of left and right side of the uterosacral-cardinal ligament on MRI and the attachment site of the starting and ending points between two group were described and compared. Results In POP group, 25 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [58% (15/26)] or coccygeal muscle [38%(10/26)], ending point were located in the cervix and vagina [58%(15/26)] or cervix [38%(10/26)];24 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [31%(8/26)]or coccygeal muscle [62%(16/26)], 26 cases of right USL ending point were located in the cervix and vagina [62% (16/26)] or cervix [38% (10/26)]; the left and right CL in the POP group and the control group were both from the sacroiliac joint at the top of the greater sciatic foramen from the ipsilateral pelvic side wall;1 case (4%, 1/26) of left CL in the POP group completely connected to the bladder, 10 cases (38%, 10/26) partly connected to the bladder;14 cases (54%, 14/26) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. In the control group, 17 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (7/18), ending point were located in the cervix and vagina (12/18) or cervix (6/18);18 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (8/18), ending point were located in the cervix and vagina (13/18) or cervix (5/18);8 cases (8/18) of left CL partly connected to the bladder;15 cases (15/18) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. There was no significant difference between the two groups on the starting and ending points (P>0.05). Conclusions The observation of MRI could be consistent with the clinical anatomy on the starting and ending points, direction of travel in the uterosacral-cardinal ligament. The starting and ending points of the left and right side USL and the ending points of the left and right side CL are not completely symmetrical, the variation degree is large, some CL could be completely or partly inserted to the bladder.
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