盆底功能障碍性疾病盆底解剖学静动态磁共振成像研究

摘要

Objective: To Compare the alterations of pelvic floor anatomy and function between the normal female and pelvic floor dysfunction(PFD) patients, to explore the relationship of PFD with specific pelvic floor anatomy abnormality, and to supply the objective bases for the pelvic floor reconstruction surgery. Methods:46 patients with PFD were recruited from January 2008 and march 2009, including 24 patients with pelvic organ prolapse(POP), 10 patients with stress urinary incontinence(SUI), 12 patients with both symptomes.14 normal women were enrolled as control group. The dynamic and static values of the areas of iliococcygeus,pubococcygeus and puborectalis, the widths of levator hiatus, the urethrovesical angle, the length of H-line and M-line,the levator angle were compared between PFD and control group. Results:The static areas of iliococcygeus,pubococcygeus and puborectalis were larger than those under dynamic status, while the dynamic width of levator hiatus was larger than that under static status in PFD group( P ＜ 0. 05 ). However,no marked changes of these markers were found in control group( P ＞ 0. 05). The urethrovesical angle,the length of H-line and M-line in PFD group were significantly larger than those in control group,while the levator angle in PFD group was smaller than that in control group( P＜0. 05). Conclusions: MRI can clearly show the anatomy and function changes of pelvic floor, and the abnormality of levator ani muscle in structure and function is associated with PFD.%目的:通过静动态磁共振成像(MRI)检查,比较女性盆底功能障碍性疾病(PFD)患者及正常女性盆底解剖结构改变,探讨盆底特定解剖学异常是否与PFD有关,为盆底重建手术提供客观依据.方法:选择2008年1月至2009年3月确诊为PFD患者46例为研究时象(PFD组),其中盆腔器官脱垂(POP)24例,压力性尿失禁(SUI)10例,POP合并SUI 12例;同期选取正常女性14例为对照组.采用静动态MRI进行盆底扫描.比较两组髂尾肌、耻尾肌及耻直肌静动态面积、肛提肌裂孔静动态宽度、膀胱尿道后角、LH线及M线长度、肛提肌角等参数值的变化.结果:PFD组患者静态髂尾肌、耻尾肌、耻直肌的面积大于动态,肛提肌裂孔宽度在静态时小于动态(P<0.05).而对照组以上参数值在静动态下无明显改变(P>0.05).PFD组患者膀胱尿道后角、LH线、M线均大于对照组,肛提肌角小于对照组(P<0.05).结论:MRI能清楚显示盆底解剖结构及功能,肛提肌的形态及功能异常与PFD有关.