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盆底动态核磁共振在女性压力性尿失禁合并盆腔器官脱垂患者诊断评估中的临床价值
引用本文:罗丹丹,成宏,倪程.盆底动态核磁共振在女性压力性尿失禁合并盆腔器官脱垂患者诊断评估中的临床价值[J].中国性科学,2020(1):67-71.
作者姓名:罗丹丹  成宏  倪程
作者单位:;1.恩施州中心医院西医部CT室
摘    要:目的探讨盆底动态核磁共振(dynamic magnetic resonance imaging,dMRI)在女性压力性尿失禁(stress urinary incontinence,SUI)合并盆腔器官脱垂(pelvic organ prolapse,POP)患者中的鉴别和诊断的价值。方法选取2018年2月至2019年2月恩施州中心医院妇科经查体确诊的35例SUI合并POP患者和同期同年龄段的25例SUI患者为研究对象。将35例SUI合并POP患者设为观察组,25例SUI患者设为对照组。两组患者均行1.5T dMRI检查和经会阴超声检查,从横断位、矢状位、冠状位影像,测量其膀胱尿道后角、尿道长度、尿道倾斜角、H线和盆膈裂孔横径指标情况;分析比较dMRI在单纯SUI和SUI合并POP中的鉴别和诊断价值,探究dMRI检查与POP分级的一致性情况。结果观察组和对照组患者静息相经会阴超声、dMRI诊断的尿道长度、膀胱尿道后角、尿道倾斜角、α角等参数比较,其差异均无统计学意义(均P>0.05);两组患者力排相dMRI检查测量的膀胱尿道后角、α角略高于超声测量数据,其差异均具有统计学意义(均P<0.05)。观察组患者dMRI静息相、力排相H线、盆膈裂孔横径2项参数差异均具有统计学意义(均P<0.05);dMRI在诊断观察组前盆腔、中盆腔脏器脱垂严重程度与POP-Q体格检查一致性良好。结论 dMRI相对于传统经会阴超声诊断技术在SUI合并POP检查中,可以更精确地测量盆底相关参数,清晰显示盆底支持结构功能状态,可以准确鉴别SUI、SUI合并POP,并且准确评估盆腔脏器脱垂程度,值得临床推广应用。

关 键 词:盆底动态核磁共振  压力性尿失禁  盆底功能障碍  盆腔器官脱垂

Clinical value of dMRI in the diagnosis and evaluation of female SUI patients with POP
LUO Dandan,CHENG Hong,NI Cheng.Clinical value of dMRI in the diagnosis and evaluation of female SUI patients with POP[J].The Chinese Journal of Human Sexuality,2020(1):67-71.
Authors:LUO Dandan  CHENG Hong  NI Cheng
Institution:(CT Room,Western Medicine Department,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,Hubei,China)
Abstract:Objective To explore the value of pelvic floor dynamic magnetic resonance imaging(dMRI) in the identification and diagnosis of female patients with stress urinary incontinence(SUI) and pelvic organ prolapse(POP). Methods From February 2018 to February 2019, 35 SUI patients with POP and 25 SUI patients of the same age in the Gynecology Department of our hospital were confirmed by physical examination. 35 patients with SUI and POP were selected as the observation group, and 25 patients with SUI were selected as the control group. Both groups underwent 1.5 T dMRI and transperineal ultrasonography. From the transverse, sagittal, and coronary images, the posterior angle of the bladder and urethra, the length of the urethra, the angle of the urethra, the H line, and the transverse diameter of the pelvic diaphragm hole were measured. The differential and diagnostic value of dMRI in pure SUI and SUI combined POP was analyzed and compared, and the consistency between dMRI and POP classification was explored. Results There was no significant difference in the urethral length, bladder urethral angle, urethral inclination angle, α angle and other parameters of the observation group and the control group between perineal ultrasound and dMRI diagnosis(all P>0.05). The bladder urethral angle and α angle were slightly higher than those measured by ultrasound, with statistically significant differences(all P<0.05). Patients in the observation group had statistically significant differences in dMRI resting phase, force-exhausting phase H-line, and pelvic diaphragmatic hole transverse diameter(all P<0.05). The diagnosis of the severity of anterior pelvic and middle pelvic organ prolapse was consistent between dMRI and POP-Q physical examination. Conclusions Compared with the traditional transperineal ultrasound diagnosis technique, dMRI can accurately measure the pelvic floor related parameters in SUI combined with POP examination, clearly show the functional status of the pelvic floor support structure, and accurately identify SUI, SUI combined with POP and the degree of pelvic organ prolapse, which is worth promoting.
Keywords:Pelvic floor dynamic magnetic resonance imaging (dMRI)  Stress urinary incontinence (SUI)  Pelvic floor dysfunction  Pelvic organ prolapse (POP)
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