肛提肌MR与CT排便造影的对照研究

目的:比较卧位MR与坐位CT排便造影2种成像技术在评价肛提肌形态及功能方面的差异。方法:对17名健康志愿者(女8例,男9例,22~24岁)行仰卧位MR和坐位CT排便造影检查。分静息、缩肛和排便3期获取盆底的冠状面图像,对肛提肌行形态学测量。结果:MR图像显示肛提肌在静息期呈穹隆状;缩肛期呈平台状,肛提肌横行部的不同部分出现矛盾运动,其中点下降(3.45±0.29)mm,内点上升(5.60±2.39)mm;排便期呈盆状,中点下降(10.76±1.10)mm,内点下降(10.47±1.29)mm。CT图像显示肛提肌在静息期呈漏斗状;缩肛期呈平台状,肛提肌横行部,中点上升(6.45±2.05)mm,内点上升(13.39±3.93)mm;排便期呈盆状,中点下降(4.40±2.01)mm,内点下降(17.45±4.05)mm。结论:卧位MR与坐位CT排便造影在评价肛提肌形态及功能方面差异显著。     

静、动态MRI用于盆底功能障碍肛提肌评价的研究进展

盆底功能障碍是由于盆底支持结构薄弱所引起的包括盆腔器官脱垂、排尿及排便功能障碍等一系列症状的疾病。肛提肌是支持盆底的主要结构,静态MRI具有较高的软组织分辨力,能客观地评价肛提肌的形态及结构,动态MRI能实时反映肛提肌的运动及功能,为其全面评估提供客观依据。就静、动态MRI在盆底功能障碍中对肛提肌评价的应用及研究进展予以综述。     

肛提肌影像学研究进展

近年来,盆底MRI动态成像已经可以显示肛提肌的活体形态变化,但是,影像学显示的肛提肌活体形态变化与传统的肛提肌功能理论之间出现了一些无法解释的矛盾,一系列新的肛提肌影像学征象的生理学意义尚需进一步研究.综述了目前肛提肌影像学的研究进展.     

肛提肌影像学研究进展

近年来，盆底MRI动态成像已经可以显示肛提肌的活体形态变化，但是，影像学显示的肛提肌活体形态变化与传统的肛提肌功能理论之间出现了一些无法解释的矛盾，一系列新的肛提肌影像学征象的生理学意义尚需进一步研究。综述了目前肛提肌影像学的研究进展。     

MRI对女性盆底功能失调肛提肌裂孔解剖及形态的研究

目的 探讨正常女性与盆底功能失调患者力排相MRI肛提肌裂孔形态及解剖结构的变化.方法 选择23名女性健康志愿者(对照组)和35例盆底功能失调患者(试验组),采用MRI三维稳态进动快速成像序列采集静息和力排相盆腔横断、冠状和矢状面影像,观测肛提肌裂孔的解剖和形态,比较力排相试验组与对照组肛提肌裂孔面积和解剖结构的变化.结果 静息相两组间肛提肌裂孔面积比较差异无统计学意义(P＞0.05),力排相试验组肛提肌裂孔面积[(35.9 ±13.1)cm2]和面积增大百分比[(64.7±22.5)％]均显著大于对照组[(21.7±4.9)cm2和(11.3±6.4)％](P＜0.01).静息相两组受试者肛提肌裂孔解剖结构由前至后均分别为尿道、阴道和肛管,力排相试验组肛提肌裂孔出现膀胱10例(31.3％)、子宫12例(37.5％)、直肠黏膜21例(65.6％)和腹膜脂肪8例(25.0％),而对照组仅发现2例(9.5％)肛提肌裂孔内出现直肠黏膜,经x2检验差异均有统计学意义(P＜0.01或0.05).结论 女性盆底功能失调患者力排相常出现多个盆腔器官向肛提肌裂孔脱垂,并导致肛提肌裂孔异常膨大.     

经会阴三维超声观察便秘产妇产后盆底结构及功能改变

 目的 经会阴盆底三维超声动态观察便秘产妇的肛提肌裂孔解剖形态及功能改变。方法 选取2014-01至2016-12在妇产科定期行产后复查的女性120例(产后组),其中有便秘症状48例(便秘产妇),无便秘症状72例(无便秘产妇),同期选取未育的无便秘症状健康妇女100例(对照组)。所有妇女均进行经会阴盆底三维超声检查,观察并测量、比较各组妇女的盆底形态结构及特征,测量各组妇女在静息状态、缩肛动作和Valsalva动作3种状态下的肛提肌裂孔面积、周长及耻骨直肠肌厚度。结果 产后妇女盆底组织结构疏松,对照组妇女肛提肌裂孔结构完整紧凑。在静息状态、缩肛动作及Valsalva动作3种状态下,产后组妇女的肛提肌裂孔面积、周长及耻骨直肠肌厚度均明显大于对照组妇女(P<0.05)。产后组便秘产妇在各种状态下的肛提肌裂孔面积及周长均明显大于非便秘产妇(P<0.05);在缩肛动作时,便秘产妇的耻骨直肠肌厚度明显薄于非便秘产妇(t=2.41,P<0.05),其余状态下的耻骨直肠肌厚度两者间比较,差异均无统计学意义(P＞0.05)。结论 产后妇女盆底解剖结构发生重塑,经会阴三维超声能有效观察产后女性尤其便秘产妇盆底解剖结构与功能的变化。     

无盆底功能障碍女性肛提肌动态磁共振成像观察

目的：探讨无盆底功能障碍女性肛提肌功能和形态变化特征。方法对20名无盆底功能障碍性疾病志愿者行盆腔动态磁共振成像（MRI）检查,测量在静息位及最大腹压时肛提肌裂隙面积、双侧耻骨直肠肌厚度、肛提肌板角度及其变化值。结果肛提肌裂隙面积：静息位（9257±1234）mm2,最大腹压（10380±1395） mm2,差异有统计学意义（P＜0．05）。耻骨直肠肌厚度：静息位（5．9±0．8）mm,最大腹压（4．7±0．6）mm,差异有统计学意义（P＜0．05）;左、右侧耻骨直肠肌厚度不对称：静息位分别为（6．0±0．8）mm、（5．8±0．7）mm,最大腹压分别为（4．8±0．7）mm、（4．6±0．6）mm,差异有统计学意义（P＜0．05）。肛提肌板角度：静息位（40±4）°,最大腹压（46±4）°,差异有统计学意义（P＜0．05）,其变化值为（6．0±1．6）°。结论动态MRI检查可以直观地观察肛提肌的形态,评价肛提肌的功能。     

女飞行员盆底功能障碍性疾病2例并文献复习

目的探讨女飞行员盆底功能障碍性疾病发病及相关情况。方法回顾分析2例女飞行员盆底功能障碍性疾病的临床诊治及航空医学鉴定情况, 应用盆底超声结合临床进行诊断, 并进行国内外文献复习。结果 2例病例中1例膀胱轻度膨出、膀胱颈移动度增大并尿道旋转角增大及膀胱后角开放、肛门内外括约肌及肛提肌无损伤, 诊断为压力性尿失禁、子宫轻度脱垂、肛提肌裂孔面积增大;1例膀胱轻度膨出、膀胱尿道漏斗形成并膀胱后角开放及膀胱颈移动度增大, 诊断为压力性尿失禁、肛提肌裂孔面积增大;2例均有临床症状。2例均属轻度病例, 航空医学鉴定结论:飞行合格。半年后随访, 2例患者行自主Kegel训练或行自主间断Kegel训练及盆底康复理疗半年余, 症状明显好转。结论女飞行员盆底功能障碍性疾病应引起重视, 早诊断、早治疗、早康复, 保障女飞行员身心健康。     

MRI与超声诊断盆腔器官脱垂的临床应用分析

目的 探讨MRI与超声检查应用于盆腔器官脱垂(POP)的临床应用价值。方法 选取100例盆底功能障碍性疾病患者,将其纳入观察组。另外选取同时期在本院行健康体检的80例受检者,将其纳入对照组,均行盆底超声检查和MRI检查,评价两种检查方式的诊断效能。结果 超声检查和MRI对静息状态、肛提肌裂孔收缩状态及最大Valsava状态下不同组间受检者肛提肌裂孔形态的变化差异有统计学意义(P<0.05),无论是超声检查还是MRI检查,观察组肛提肌裂孔周长、面积均高于对照组,差异有统计学意义(P<0.05),超声检查和MRI检查与金标准的一致性较强;超声检查的灵敏度为84.38%,低于MRI检查的95.29%;MRI诊断的特异度为90.00%,高于超声检查的67.86%,两者比较差异有统计学意义(P<0.05),但超声检查诊断的AUC值高于MRI。结论 盆底超声检查和MRI应用于POP诊断中均具有不可替代的作用,相比之下超声检查更简便易行,可重复性更高。     

四维盆底超声在电刺激联合生物反馈结合盆底肌锻炼治疗压力性尿失禁疗效评估中的价值

目的:探讨四维盆底超声在电刺激联合生物反馈盆底肌锻炼治疗压力性尿失禁(SUI)疗效评估中的价值.方法:选择60例SUI患者,电刺激联合生物反馈盆底肌锻炼3个月后分析治疗效果;并于治疗前后采用经会阴四维盆底超声记录患者肛提肌裂孔面积、裂孔左右径、肛提肌厚度、膀胱颈移动度、膀胱尿道后角及尿道内口漏斗形成率.结果:治疗后,肛...     

Anatomie und Funktion des Beckenbodens

PELVIC FLOOR: Anatomy of the pelvic floor seemed to be clearly. In opposite the physiology of the Levator ani and the endopelvic fascia is not yet fully understood. Especially the anatomic form of the levator plate does not conform with physiologic concepts. PELVIC STRUCTURES: Pelvic structures can be divided in three groups: the hollow organs, the endopelvic fascia and the muscles. The M. levator ani is the muscle of the pelvic diaphragm. Its parts were given different names (Fig. 1, 4) depending on their function or localization. In anatomic studies the pelvic floor is described as basin-shaped. In contrast to the anatomic results based upon the evaluation of cadavers, dynamic MRI gave different concepts: at rest the levator ani probably has the shape of a dome and differ when contract. The urogenital diaphragm is mostly a fascia and contains only fair muscular components. Therefore, many authors do not accept the term "diaphragm" and the physiologic function is still a matter of discussion. The endopelvic fascia has to fix the organs in the pelvis and forms "streets" for vascular and nervous supply. CONCLUSION: Describing anatomic structures in the common planes (transversal, sagittal, frontal) will help to understand CT- and MRI-imaging.     

MR-based three-dimensional modeling of the normal pelvic floor in women: quantification of muscle mass

OBJECTIVE: Our objective was to use a combination of axial MR source images and three-dimensional (3D) models to describe the anatomy of the normal pelvic floor in young nulliparous women and to measure the volume of the levator ani. SUBJECTS AND METHODS: Ten healthy nulliparous female volunteers (average age, 27 years) underwent T2-weighted MR imaging of the pelvis. Three-dimensional color-coded models of the pelvic bones and organs and the three major components of the levator ani--puborectalis, iliococcygeus, and coccygeus--were created. Source images were used to measure muscle width and signal intensity and to identify ligamentous structures. Using 3D models, we measured the volume of the levator ani, the angle of the levator plate, the posterior urethrovesical angle, and the distance of the bladder neck from the symphysis pubis and the pubococcygeal line. RESULTS: In all volunteers, the signal intensity of the puborectalis exceeded that of the obturator externus. The average volume of the levator ani was 46.6 ml, the average width of the levator hiatus was 41.7 mm, and the average posterior urethrovesical angle was 143.5 degrees. Vaginal shape in the volunteers followed no recognizable pattern. CONCLUSION: Muscle morphology, signal intensity, and volume is relatively uniform among healthy young women.     

MRI对分娩并发肛提肌损伤的评价研究

目的探讨女性正常肛提肌与肛提肌损伤的MRI表现，评价分娩与肛提肌损伤的相关性。方法选择100例健康未产妇（对照组）和200例经阴道分娩初产妇（研究组），研究组进一步分为压力性尿失禁组（研究A组）和无症状组（研究B组）各100例。采用MR质子加权像对其盆部进行多方位扫描，比较正常肛提肌与其损伤的MRI特征。结果对照组肛提肌均表现正常，研究组中54例（27％）（研究A组42例，研究B组12例）有明显的肛提肌损伤，其中49例位于耻骨直肠肌，5例位于髂骨尾骨肌（x^2=41．447，P〈0．01）。耻骨直肠肌损伤多表现为单侧或双侧部分缺损，髂骨尾骨肌损伤表现为肌肉明显萎缩。结论经阴道分娩是引起肛提肌损伤的重要原因，其损伤可导致盆腔器官脱垂和盆底功能障碍性疾病，初产妇肛提肌损伤多发生于耻骨直肠肌，MRI是检测肛提肌损伤的有效手段。     

盆腔器官脱垂女性肛提肌静动态MRI三维变化特点

目的探讨盆腔器官脱垂(POP)女性肛提肌静动态MRI三维变化特点。方法前瞻性收集2014年9月—2017年4月于南方医科大学南方医院就诊的中老年POPⅡ-Ⅳ度女性病人30例[(56.5±10.20)岁]及中老年已育无POP女性20例[(48.2±9.20)岁]作为对照。受试者均行静动态MRI检查,通过Mimics 10.01构建静动态肛提肌三维模型。二维观察指标包括肛提肌裂孔形态及髂尾肌形态,三维测量指标包括肛提肌裂孔横径、前后径,肛提肌起始处距耻骨联合下缘距离、肛提肌板角度。采用配对样本t检验比较组内静动态肛提肌测量指标,采用两独立样本t检验比较2组间肛提肌测量指标的差异,采用卡方检验比较计数资料。结果最终顺利构建26例POP组及20例对照组肛提肌三维模型。POP组动态较静息肛提肌裂孔异常"U"形及"O"形增多,髂尾肌异常"漏斗"形及"凹槽"形增多,差异均有统计学意义(P0.05);对照组静动态MRI无明显变化(P0.05)。POP组和对照组的肛提肌动态三维测量指标均较静态增大(P0.05)。静息时,POP比对照组肛提肌裂孔前后径、肛提肌距耻骨联合下缘左右侧距离明显增大(P0.05),余无明显差异(P0.05);动态时,POP比对照组肛提肌三维测量指标均明显增大(P0.05)。结论中年已育女性虽无POP症状,但肛提肌趋向松弛改变;屏气用力下POP组肛提肌形态改变更明显,说明肛提肌支撑力的减弱与POP的发生密切相关。     

女性盆腔器官脱垂病人肛提肌的MRI评价

盆腔器官脱垂是指由于盆底支持结构薄弱而导致盆腔脏器脱离正常的解剖位置。肛提肌是盆底支持结构中的重要组成部分,其结构损伤及功能障碍是盆腔器官脱垂的重要致病原因,因此对肛提肌的解剖结构进行详细描述成为盆腔器官脱垂研究的关键。动态MRI、扩散张量成像和纤维束示踪技术以及三维有限元分析等MRI技术能够提供肛提肌形态、运动、功能、微观结构以及生物力学等方面的信息,对于探索盆腔器官脱垂发病机制、完善其临床诊断和治疗具有重要的价值。     

静动态MRI在盆腔器官脱垂术前与术后中的应用

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(POP-Q)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(B-PCL)、子宫颈到 PCL 的垂直距离(U-PCL)、Douglas 窝到 PCL 的垂直距离(D-PCL)、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 B-PCL、U-PCL、D-PCL、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 B-PCL、U-PCL、D-PCL、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。     

Dynamic imaging of the pelvic floor using an open-configuration magnetic resonance scanner

The aims of this study were to develop a noninvasive, erect, gravity-dependent method for assessing movements of the female pelvic floor, to describe the range of movements in pelvic floor ascent and descent in asymptomatic and symptomatic women, and to quantify any differences. A total of 102 women, 28-86 years of age, 35 symptomatic and 67 asymptomatic, were included in the study. They were scanned in a sitting position in an open scanner with good vertical access using fast-gradient echo sequences fast spoiled grass (FSPGR). Measurements of the bladder base, uterocervical junction, and anorectal junction were taken in the sagittal plane. The levator ani (LA) muscle insertion was assessed in the coronal plane with the patients at rest, during maximal strain, and during maximum contraction of the pelvic floor. Premenopausal multiparous women have a significantly lower bladder base (8/0 mm above the baseline; P value = 0.009) and uterocervical junction (15.5/3.5 mm; P value = 0.03) at rest than nulliparous women, and this becomes more apparent on straining. Parity confers a more significant effect on the position and function of the pelvic floor than menopausal status. All pelvic organs are lower at rest and on straining in women with defecation difficulties (0/-24 mm; P value = 0.001). These differences are also seen when comparing women with and without urinary incontinence. Dynamic seated magnetic resonance imaging (MRI) shows that all the pelvic organs are lower at rest and on straining in multiparous women and in those with urinary incontinence than in a group of asymptomatic nulliparous volunteers. This difference is also seen in the position of the bladder base and anorectal junction during pelvic floor contraction. These findings suggest general pelvic floor weakness in women who present with symptoms in one compartment and indicate the need for evaluation of the entire pelvic floor particularly prior to surgery. J. Magn. Reson. Imaging 2001;13:923-929.