【摘要】 目的 探讨静动态MRI在盆腔器官脱垂(POP)术前诊断、术后疗效评价中的价值。方法 经盆腔器官脱垂量化分度法(POPQ)诊断为POP的患者29例，对照组为年龄、产次和体质量与之匹配的无症状志愿者12例，行静态和动态盆底MRI检查，观察盆底结构形态学变化，测量POP患者术前、术后及对照组动态MRI图像上各指标：膀胱下缘到耻尾线(PCL)的垂直距离(BPCL)、子宫颈到PCL的垂直距离(UPCL)、Douglas窝到PCL的垂直距离(DPCL)、耻骨直肠肌裂孔线(H线)、盆底肌下降距离(M线)、肛提肌裂孔面积(LHS)、肛提肌板角度(LPA)、髂尾肌角度(ICA)、尿道倾斜角(UA)。结果 POP患者术前MRI上诊断膀胱膨出19例，子宫脱垂28例，直肠膨出4例，Douglas窝疝14例，盆底松弛29例，发现肛提肌缺陷27例，耻骨宫颈筋膜缺陷24例。POP患者术前BPCL、UPCL、DPCL、H线、M线、LHS、LPA、ICA及UA等测量值均大于对照组，其差异均有非常显著意义(P<0.01);21例POP术后患者中，MRI发现9例盆腔器官位置恢复正常，12例仍有脱垂；8例网片植入患者术后MRI显示网片无移位；POP患者术后BPCL、UPCL、 DPCL、UA测量值较术前缩小，其差异有统计学意义(P<0.05)。结论 静动态MRI可全面评价POP术前、术后盆底形态和功能改变，检出隐匿的脱垂和术后残存。更多还原

【Abstract】 Objective To explore the value of static and dynamic MRI before and after operation of pelvic organ prolapse(POP). Methods 29 patients with POP(POP group) and 12 normal women(control group) underwent static and dynamic MRI. The morphologic changes of pelvic floor were observed on MR images. The measurements of bladder, uterus, Douglas pouch to pubococcygeal line(B-PCL, U-PCL, D-PCL), the puborectal hiatus line(H-line),muscular pelvic floor descent(M-line),the levator hiatus size(LHS), the levator plate angle(LPA), the iliococcygeus angle(ICA) and the urethral inclination angle(UA) were recorded on dynamic MR images. Results 19 cystoceles, 28 uterine prolapses, 4 rectoceles and 14 hernias of Douglas pouch were detected with MRI. 29 cases of pelvic floor relaxation, 27 cases of levator ani muscle defect and 24 cases of pubocervical fascial defect were found. The values of B-PCL, U-PCL,D-PCL,H-line, M-line, LHS,LPA,ICA and UA of POP group were larger than control group(P<0.01). The positions of pelvic organ returned to normal in 9 cases of 21 postoperative cases, while 12 cases remained prolapses. There was no displacement of mesh in 8 cases of mesh implant.The values of B-PCL,U-PCL,D-PCL,UA after operation were smaller than those before operation(P<0.05).Conclusion Static and dynamic MRI can evaluate morphological and functional changes of pelvic floor before and after operation of POP comprehensively, and may reveal those invisible pelvic floor dysfunction and postoperative remnant defects.更多还原