【摘要】 目的探讨利用动态磁共振成像(magnetic resonance imaging,MRI)原始数据集构建盆腔器官脱垂(pelvic organ prolapse,POP)盆腔器官及肛提肌动态三维模型的方法及意义。方法选取1例于2014年10月在南方医科大学南方医院行盆腔动态MRI扫描的POP患者,利用计算机三维重建软件构建静息及最大脱垂状态骨盆、盆腔器官及肛提肌三维模型,并对其进行三维测量,包括:肛提肌板角度,肛提肌裂孔横径及前后径;膀胱颈、宫颈内口、肛管直肠连接处距耻尾线(pubococcygeal line,PCL)的投影距离。结果 (1)最大脱垂状态时膀胱失去正常形态,从阴道前壁向前下脱出;阴道前壁呈凹槽状,子宫从后下脱入阴道内;肛直肠向后下移位。(2)最大脱垂状态与静息状态相比,肛提肌板角度增大15.25°,肛提肌裂孔横径增大5.88 mm,肛提肌裂孔前后径增大16 mm。盆腔器官垂直方向下移:膀胱:43.46 mm,子宫:46.48 mm,直肠:18.91 mm。结论 POP盆腔器官及肛提肌动态三维模型可以再现POP患者达最大脱垂程度时盆腔结构的真实状态,是对静息盆腔器官及肛提肌数字化三维模型的重要补充,有望为盆底手术提供个体化的解剖学和功能学参考。更多还原

【Abstract】 Objective To explore the method and significance of constructing dynamic three-dimensional model of pelvic organs and levator ani muscle in female pelvic organ prolapse patient based on dynamic magnetic resonance imaging.Methods One female patient diagnosed with pelvic organ prolapse was chosen, who undertook dynamic magnetic resonance imaging scanning in Nanfang Hospital of Southern Medical University in Oct 2014,and 3D reconstruction software was used to reconstruct and align the three dimensional pelvic bone,pelvic organs and levator ani muscle in resting and maximum prolapse state; 3D measurement tools were adopted to measure following indicators:the 1evator plate angle,levator hiatus width and length, bladder neck,cervical and anorectal junction vertical projection distance from PCL(pubococcygeal line).Results(1)At the maximum prolapse state,bladder lost its normal shape,prolapsing from the anterior vaginal wall; the anterior vaginal wall was groove-shaped; uterus prolapsed into the vagina, uterus and rectum all moved back and down(.2)Compared with resting state, at the maximum prolapse state,1evator plate angle increased by 15.25°,levator hiatus width increased by 5.88 mm and levator hiatus length increased by 16 mm; pelvic organs moved down:bladder:43.46 mm,uterus:46.48 mm,rectum:18.91 mm.Conclusions Dynamic three-dimensional model of pelvic organ and levator ani muscle in FPOP can reproduce the true state of pelvic structures when patient reached maximum degree of prolapse,which is an important complement to the simple resting three-dimensional model;moreover, it may provide individualized anatomical and functional reference for pelvic floor surgery.更多还原