盆底MRI在女性压力性尿失禁诊疗中的应用价值

目的 探讨盆底MRI在女性压力性尿失禁(SUI)诊疗中的应用价值。方法 前瞻性收集2017年1月至2019年1月首都医科大学附属北京朝阳医院的SUI组和对照组受试者,部分SUI患者行尿道中段悬吊带术(TVT)治疗。受试者均行盆底动态MRI检查(静息相及力排相),对SUI组尿道、膀胱颈功能及盆腔器官脱垂进行定性、定量诊断,分析SUI组TVT术后尿道移动角度、膀胱颈及尿道开放、盆底器官脱垂程度变化。采用独立样本t检验(正态分布)或秩和检验(偏态分布)比较对照组和SUI组患者计量资料的差异,采用χ2检验比较计数资料的差异。结果 对照组25例,SUI组33例,31例行TVT治疗,其中12例于术后3~ 6个月复查盆底MRI,纳入术后观察。力排相下,SUI组较对照组,功能尿道长度、尿道移动角度、H线、M线、膀胱漏斗征、尿道开放和膀胱脱垂的差异有统计学意义(P<0.05)。膀胱漏斗征及尿道开放征术前、后的差异有统计学意义(P<0.05)。TVT术后SUI患者的膀胱脱垂程度减小,子宫脱垂程度增大,但差异无统计学意义(P>0.05);TVT术后SUI患者的尿道长度增加,尿道移动角度减小,但差异无统计学意义(P>0.05)。结论 盆底MRI能准确评估SUI盆底功能;TVT术后对尿道支持结构薄弱及盆底器官脱垂无明显改善。

The value of MRI in assessment of the functional disorders of stress urinary incontinence in women

Objective To investigate the application value of MRI in evaluating the disorders of pelvic floor in female stress urinary incontinence(SUI).Methods From January 2017 to January 2019,the patients in the SUI group and the control group of Beijing Chaoyang Hospital,Capital Medical University were prospectively collected.Some patients in the SUI group were treated with tension-free vaginal tape(TVT).The dynamic MR was performed in both SUI patients and volunteers,and the following functional MR parameters were assessed between two groups:the urethral length and urethral hypermobility;the opening of urethral and bladder neck;and the pelvic organ prolapse.For SUI patients,the functional changes of the pelvic floor on MRI after TVT was also analyzed.Chi-square test,rank-sum test and t test were used.Results Comparing with the control groups(n=25),the urethral hypermobility,shortening functional urethral length,bladder neck funneling and urethra opening were significantly associated with SUI group(n=33).Thirty one patients were treated with TVT,12 of them were reexamined with MRI at 3 to 6 months after operation.Postoperative MR showed that SUI patients had lower risk of the urethral opening and bladder neck funneling(P<0.05).There were significant differences in the length of functional urethra,angle of urethra movement,H-line,M-line,bladder funnel sign,urethra opening and bladder prolapse between the two groups(P<0.05).There was a significant difference between the bladder funnel sign and urethra open sign before and after TVT(P<0.05).There was no significant difference in the degree of bladder prolapse and uterus prolapse,length of urethra and angle of urethra movement between the two groups(P>0.05).Conclusion MRI can accurately evaluate pelvic floor function of SUI patients.However,TVT did not significantly improve weak pelvic supporting structures and pelvic organ prolapse.