基于CT图像的女性尿道三维成像

目的 探讨女性尿道的三维成像方法及其意义.方法 对正常控尿女性的膀胱、尿道进行CT的横截位连续扫描,在此基础上手工勾画尿道的轮廓,在个人电脑上利用三维成像软件进行女性尿道三维成像的初步探索.结果 CT连续扫描显示,女性的尿道在增强影像上与周围组织可以区分开.经三维成像显示,女性尿道的平滑肌肉与膀胱的肌肉相连续,在中段较粗,对应于组织学上括约肌最丰富处;中外1/3处尿道有一个略向前的弯曲,与大体的病理观察、临床观察相吻合.结论 增强CT可以显示女性尿道;三维成像可以显示尿道的轮廓,这为今后的研究及临床应用提供一个可供选择的方法.     

女性控尿解剖学机制的MRI研究

目的探讨女性控尿的解剖学机制在MRI（磁共振成像）的表现和观察方法。方法对20例正常控尿的成年女性进行MRI扫描，采用八通道体部线圈、快束自旋回波（FSE）扫描序列进行扫描，采集静息时盆腔横断面、矢状面和冠状面影像。结果MRI显示，女性的尿道分三层结构，与病理学对照，由内向外依次为黏膜及黏膜下组织、肌肉、外膜组织，但无法区分平滑肌与括约肌；与控尿有关的盆底肌肉也能够清楚显示。结论MRI能够清楚观察到女性控尿的有关解剖结构，是观察女性控尿解剖结构的较理想影像方法。     

螺旋CT双期增强薄层扫描对小胰腺癌的诊断价值

目的:研究螺旋CT胰腺期、肝脏期双期增强薄层扫描在小胰腺癌早期诊断中的作用.方法:对25例小胰腺癌患者行螺旋CT双期增强扫描,扫描延迟时间分别为38s和70s,胰腺期行2mm层厚,螺距1.0扫描,并对胰腺期扫描分别以2mm间隔及5mm层厚和5mm间隔重建.对1cm＜病灶＜2cm和病灶＜1cm在2mm层厚图象与5mm层厚重建图像上显示情况进行对比观察研究,并对术前预测和术后进行对比.结果:两组观察结果经统计学处理检出率有显著性差异:对1cm＜病灶＜2cm检出率p<0.01,对病灶＜1cm检出率p<0.025;术前预测可切除性和不能切除和术后进行对比没有明显差异P＞0.1.结论:螺旋CT动态增强薄层扫描可明显提高小胰腺癌和微胰腺癌的检出率,对小胰腺癌的早期诊断有重要的临床价值.肝脏期扫描为临床确定肿瘤是否能够手术切除提供科学依据.     

女性压力性尿失禁术后患者行盆底肌肉锻炼的控尿效果观察

目的探讨女性压力性尿失禁术后患者行盆底肌肉锻炼的效果。方法回顾性分析医院100例轻、中度压力性尿失禁患者临床治疗情况,其中以常规药物治疗者为对照组,50例;行盆底肌肉锻炼者为观察组,50例。评价两组治疗前后排尿状况和盆底肌力评分,记录两组控尿效果(漏尿量、漏尿程度、漏尿次数)。根据患者治疗状况以问卷形式调查患者治疗效果。结果两组患者治疗后排尿状况评分较治疗前显著下降,观察组下降更显著,而盆底肌力评分明显升高,观察组升高程度显著,P0.05。观察组漏尿次数、漏尿量,明显少于对照组,且漏尿程度低于对照组,P0.05。观察组患者主观疗效明显优于对照组,P0.05。结论女性压力性尿失禁患者术后行盆底肌肉锻炼可通过提高患者盆底肌力来起到较好的控尿效果,值得推荐。     

多层螺旋CT三维重建成像技术在输尿管梗阻诊断的价值

目的:探讨多层螺旋CT三维重建成像技术对输尿管梗阻诊断的临床价值。方法:回顾性分析临床输尿管梗阻病变30例临床资料,所有病例均行螺旋CT增强扫描。扫描图像减薄,层厚2.5mm,层间距2.5mm。所有数据传入工作站进行三维重建,并对重建后输尿管图像与CT轴位平扫图像及X线平片对比分析。结果:三维重建泌尿系图像清晰显示输尿管空间结构。结论:多层螺旋CT三维重建技术获得的图像能以最优形式清晰、立体地显示输尿管解剖结构及空间位置关系,对诊断输尿管梗阻原因具有重要价值。     

多层螺旋CT尿道成像在尿道狭窄诊断中的应用

目的 探讨多层螺旋CT尿道成像技术在尿道狭窄诊断中的应用价值.方法 对20例因各种原因引起的尿道狭窄病例同时进行普通X线排尿造影和多层螺旋CT尿道成像枪查,观察尿道狭窄情况,与手术结果对照,并进行统计学分析.结果 多层螺旋CT尿道成像不仪能显示尿道狭窄部位和狭窄稃度,而且能显示尿道狭窄处与周围组织的关系,而后者在普通x线排尿造影中无法显示.结论 多层螺旋CT尿道成像分辨率高,较普通X线排尿造影显示尿道狭窄更具优势.     

16层螺旋CT三维重建技术在泌尿系病变诊断中的应用价值

目的探讨16层螺旋CT三维重建技术在泌尿系病变增强延时扫描时的应用价值.方法 28例泌尿系病变病例行16层螺旋CT平扫、双期增强扫描以及延时尿路造影扫描,利用后处理技术对延时扫描资料进行三维重建处理,可以得到包括肾盏、肾盂、输尿管及膀胱在内的完整尿路三维成像.结果 16层螺旋CT延时尿路造影清晰显示了泌尿系的解剖结构,以及病变和尿路之间的空间关系.28例患者中,诊断肾盂输尿管重复畸形5例,肾位置异常2例,巨输尿管2例,腔静脉后输尿管3例,泌尿系结石8例,肾输尿管肿瘤8例,肿瘤病例均经手术病理证实.CT诊断与临床诊断符合率100%.结论 16层螺旋CT增强延时尿路造影扫描,对显示泌尿系病变部位、病因和尿路梗阻的程度具有高速、后处理快捷、安全可靠的特点,可提供高分辨尿路图像,可作为诊断泌尿系疾病的一种新型无创伤影像学方法.     

螺旋CT扫描重建在评估腰椎椎间融合术后骨性融合中的价值

目的探讨16排螺旋CT评估腰椎后路椎体间融合结合椎弓根钉内固定术后椎体间骨性融合的最优化参数和临床应用价值。方法对腰椎后路椎体间融合结合内固定术后1-4．5年的52例病例59个融合节段，应用16排螺旋CT薄层扫描，做冠状位和矢状位重建，观察椎体间的骨性融合情况，并与腰椎动力位X线片的评估方法进行对照研究。结果应用16排螺旋CT，采用0．75mm层厚做螺旋扫描，采用B30fmediumsmooth卷积核做lmm重建，获得冠状位和矢状位重建图像。术后1年CT扫描示59个融合节段中，38个节段达到完全骨性融合；21个节段出现锁定的假关节征象，术后2年除1例单节段出现此现象病例因时间关系未再次行CT评估外，其余行CT扫描示20个节段中16个节段有连续性骨小梁通过，4个节段仍存在锁定的假关节征象，其中1个节段出现透亮带边缘骨质硬化。在4．5年的研究期间，重建CT观察到54个节段达到椎体间骨性融合（91．53％），另5个节段虽未达到骨性融合，但也无典型假关节征象。同期的腰椎动力位X线片评估均认为融合率为100％。结论应用16排螺旋CT，以0．75mm层厚做螺旋扫描，采用B30fmedium smooth卷积核做1mm冠状位和矢状位上的重建，可作为腰椎后路椎体间融合结合内固定术后评估椎体间骨性融合的可靠指标之一。     

多层螺旋CT后处理技术在踝关节隐匿性骨折中的价值

目的 探讨多层螺旋CT后处理技术在踝关节隐匿性骨折诊断中的价值. 方法 收集2010年11月至2012年10月,35例后踝骨折患者进行多层螺旋CT扫描及三维重建. 结果 多层螺旋CT扫描对局限性线样骨折的显示优于常规X线平片,而且三维重建可以更全面、立体地观察骨折全貌及伴随病变的特征,弥补了X线平片和轴位CT扫描的不足. 结论 多层螺旋CT后处理技术能够直观、立体地显示踝关节骨折的特征,在踝关节隐匿性骨折的诊断和治疗中具有重要的价值.     

多排螺旋CT非螺旋低剂量扫描筛查肺结节

目的探讨4排螺旋CT非螺旋低剂量扫描方式在肺结节诊断中的价值。方法对30例胸片可疑肺结节患者分别行螺旋低剂量和非螺旋低剂量扫描。采用Toshiba 4排多层螺旋CT（Asteion 4）扫描机。螺旋扫描采用预设35.5 mAs,床进20 mm/圈（即螺距1）,0.75 s/圈,非螺旋扫描预设24 mAs,床进20 mm/圈（层厚=层距）,0.48 s/圈,其他扫描参数相同：120 kV,准直0.5×4,DFOV 300 mm,重建层厚5mm。根据出现伪影程度及是否分辨出肺结节来评价CT图像质量,对肺结节进行简单计数。比较两者发现肺结节的差异及有效放射剂量的差异。结果两种扫描方式检查30例患者均为阳性,发现各种肺结节都是108个。非螺旋扫描的有效放射剂量低于螺旋扫描方式（P〈0.001）。结论非螺旋方式扫描与螺旋方式扫描在胸部低剂量检查中对于肺内病灶的发现及诊断无统计学差异,扫描剂量相对更低的非螺旋方式扫描应用于胸部疾病的诊断及筛查是可行的。     

The role of the pelvic floor in female urinary incontinence

This paper presents a review of the various factors believed to be involved in female urinary continence. Components within the wall of the urethra include smooth muscle, the striated muscle of the rhabdosphincter, elastic connective tissue, a subepithelial vascular component, and the urethral epithelium. Extramural factors comprise the fascial support of the bladder neck and proximal urethra, the transmission of intra-abdominal pressure to the urethra, and the periurethral muscles of the pelvic floor. Special emphasis is placed on the periurethral muscles, and the anatomy, innervation, and histochemistry of the levator ani are discussed. This account is followed by consideration of evidence that partial denervation of the levator ani may be an etiological factor in female genuine stress incontinence of urine. Finally, various non-invasive methods for the relief of genuine stress incontinence are discussed, including pelvic floor exercises and the use of intravaginal cones and electrostimulation.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Bildgebende Diagnostik des männlichen Beckenbodens

The understanding of the female pelvic floor during the last 20 years was very much influenced by the new techniques of sonographic and magnetic resonance imaging (MRI). Functional imaging of the male pelvic floor is, however, still in its infancy. In analogy to ultrasound examinations of the female pelvic floor, perineal ultrasound can be also be applied to men. The mobility of the proximal urethra, scarring of the bladder neck or implanted suburethral meshes can be easily visualized. Studies on healthy men provide information about different muscular structures during micturition. Morphology and function of the external sphincter can be visualized with transrectal or intraurethral ultrasound and also with a perineal approach. Using functional MRI the complex interactions of bladder, urethra, external sphincter and pelvic floor muscles can be evaluated. Functional MRI is so far not generally available but enables a better understanding of the function of the male pelvic floor. Imaging of the male pelvic floor makes a substantial contribution for improving surgical procedures for male incontinence in the future.     

Funktionelle Anatomie des weiblichen Beckenbodens

Knowledge of functional anatomy is a prerequisite for the safe and targeted reconstructive therapy of incontinence and the prolapse syndrome of the female pelvic floor. We illustrate the interaction of muscles and connective tissue of the pelvic floor with anatomical illustrations and demonstrate their impact on the function of the urethra, bladder, vagina, uterus and rectum. Examples for the therapeutic rationale for a surgical reconstruction of the pelvic floor are defined and justified from their functional anatomy.     

女性解剖性前盆腔脏器清除术对控尿机制的影响

目的:探讨女性解剖性前盆腔脏器清除术对控尿机制的影响,以进一步指导相关临床工作和研究。方法:对符合研究需要的成人女性尸体20具进行控尿神经的大体解剖,然后模拟行经耻骨后解剖性前盆腔脏器清除术,以明确可能会损伤控尿神经的操作,并提出相应的防范措施。结果:女性盆丛的阴道丛和尿道丛有神经分支进入尿道,其中膀胱尿道丛量较少,紧贴盆侧壁几乎与尿道上缘平行走向尿道。阴部神经的阴蒂背神经和阴部神经发出神经支配尿道,以阴部神经为主要。明确上述控尿神经,模拟手术表明:紧贴盆壁的操作、尿道近端切除>0.5cm、吻合尿道-新膀胱进针过深等均易于损伤控尿神经和肌肉操作。结论:手术中应针对易于损伤的控尿神经、肌肉操作因素进行防范,有助于女性控尿机制的保护。     

An anatomical description of the male and female urethral sphincter complex

PURPOSE: We performed a detailed study of the lower urinary tract of the male and female human fetus to elucidate the anatomy of the urethral sphincter complex in both sexes and its relationship to the surrounding organs and tissues. MATERIALS AND METHODS: A total of 12 male and 14 female normal human pelvic specimens ranging from 17.5 to 38 weeks of gestation were studied by serial sections and immunohistochemical analysis. Three-dimensional reconstructions were created from serial sections to demonstrate the anatomy of the lower urogenital tract and urethral sphincter in both sexes. Specific attention was directed to the sphincteric muscle of the urethra. RESULTS: The urinary continence mechanism is formed by a combination of detrusor, trigone and urethral sphincter muscles with distinctive histological characteristics in both sexes. In males the external urethral sphincter covers the ventral surface of the prostate as a crescent shape above the verumontanum, horseshoe shape below the verumontanum and crescent shape along the proximal bulbar urethra. The levator ani muscles form an open circle around the external sphincter with a hiatus at the ventral aspect. In females the external urethral sphincter covers the ventral surface of the urethra in a horseshoe shape. Caudally the same horseshoe-shaped external sphincter increases in size to envelop the distal vagina. The levator ani muscles do not support the proximal urethra. The smooth and striated muscle components of the urethral sphincter complex are inseparable in both sexes. CONCLUSIONS: The developmental anatomy of the urethral sphincter complex is analogous in both sexes. The male and female urinary sphincter mechanism is composed of detrusor, trigone and urethral muscles, each of different muscular origins. The levator ani does not surround the ventral aspect of the urethra and may not have an active role in continence in both sexes. This new concept in the anatomy of male and female sphincter morphology may help to refine our reconstructive and ablative surgical techniques.     

电刺激治疗仪治疗女性尿失禁81例

目的 探讨电刺激治疗仪在女性尿失禁治疗中的作用机制及疗效。方法 应用置于阴道内的电极探头,在不同的电流状态下,间歇刺激阴部神经,达到抑制逼尿肌收缩、增加尿道阻力,从而控制尿液渗漏,采用此法治疗81例不同程度的尿失禁患者。结果 尿失禁患者渗、漏尿事件减少47.5％,尿频次数减少46％,24h内排尿次数在10～12次之间;患者的整体的主观改善率为66％,整体的客观改善率为74.5％。结论 电刺激治疗仪在女性尿失禁治疗有明显疗效,可提高患者的生活质量。     

Urethral function after cystectomy: a canine in vivo experiment

Summary To study the function of the pelvic floor and the isolated urethra after removal of the bladder, 5 male and 5 female mongrel dogs were used in an acute in vivo experiment. Urethral pressure changes secondary to unilateral stimulation of the pelvic and pudendal nerves were recorded. After baseline data of the intact system were documented, the following procedures were carried out: separation of the urethra from the bladder neck (prostate), nerve-sparing cystectomy (cystoprostatectomy), and cold-knife incision through the entire length of the proximal urethra. Pressure recordings were repeated after each step of surgery. Pudendal nerve stimulation resulted in rapid and large pressure rises in the distal urethra (reaction typical of striated muscle). This response remained unchanged after all three surgical steps. Pelvic nerve stimulation provoked pressure rises within the urethra of a pattern typical of smooth muscle. The findings persisted after separation of the urethra from the bladder neck (prostate) and after cystectomy, but were not observed after urethrotomy. Contractions secondary to pudendal nerve stimulation were inhibited by curare, which did not affect the reaction to pelvic nerve stimulation. Our experiments demonstrate that in the dog the continuity of bladder and urethra is not required for the function of urethral closure mechanisms. The contractile potency of the urethral smooth muscles remains intact after nerve-sparing cystectomy. We believe that problems with the baseline continence of surrogate bladders should mainly be ascribed to a lack of surgical caution in preserving the autonomic nerves of cystectomy. A poor response to stress conditions cannot be explained by damage to the neural pathway of the striated sphincter, as the pudendal nerve is not at risk during nerve-sparing cystectomy. In our opinion mechanical malfunction of the striated muscle components secondary to scarring at the site of the anastomosis is the main reason for stress incontinence after orthotopic bladder replacement.