断层超声成像及磁共振成像技术对产后女性肛提肌撕脱的评价

目的分别采用盆底三维超声断层超声成像技术（TUI）和盆底磁共振成像技术（MRI）研究肛提肌尿道间隙（LUG）和肛提肌耻骨间隙（LSG）在产后肛提肌撕脱女性的变化，探讨LUG、LSG在评价产后肛提肌撕脱情况的应用价值。 方法选取2015年12月至2016年10月在上海交通大学附属第六人民医院就诊的经阴道分娩的产后女性，采用经会阴三维超声随访，筛选出肛提肌撕脱女性20例，选择未育组女性20例作为对照组。采用TUI获得盆底的断层超声图像，在最小盆膈裂孔及其上下各一个平面测量两侧的LUG，取均值。采用MRI获得盆底薄层图像，并重建出盆底结构三维立体模型，在三维模型上测量LSG，两侧分别测量。 结果对照组肛提肌均无撕脱，LUG值为（17.80±1.39）mm，LSG值为（19.71±1.94）mm。产后撕脱组28侧肛提肌撕脱，12侧无肛提肌撕脱。撕脱侧LUG值明显大于无撕脱侧［（27.94±2.53）mm vs （19.78±1.35）mm］，差异有统计学意义（t=8.352，P<0.05）；撕脱侧LSG值明显大于无撕脱侧［（37.39±4.11）mm vs （21.81±2.96）mm］，差异有统计学意义（t=8.352，P<0.05）。 结论TUI与MRI均可用于诊断肛提肌撕脱，LUG与LSG是有效的评估肛提肌撕脱的影像学参数。

A preliminary application of tomographic ultrasound imaging and magnetic resonance imaging in evaluating levtor avulsion in postpartum women

ObjectiveTo study the changes of levator-urethra gap (LUG) by tomographic ultrasound imaging (TUI) and levator-symphysis gap (LSG) by magnetic resonance imaging (MRI) in postpartum females. MethodsTwenty postpartum women with levator avulsion and 20 nulliparas were examined by TUI and LUGs were measured on the slice 0,1 and 2. Magnetic resonance imaging scans of levator ani muscle were obtained in thin slices. Then a three-dimensional model of the levator ani muscle was created by Mimics software. LSGs were measured on three-dimensional models. ResultsNone levator avulsion were found in the images of 20 nulliparas. LUG was (17.80±1.39) mm and LSG was (19.71±1.94) mm. The levator avulsions were found in 28 sides, and 12 sides were without levator avulsion. The LUG of levator avulsion (27.94±2.53) mm was greater than that of intact levator ani muscle (19.78±1.35) mm, and the difference was statistically significant (t=8.352, P<0.05). The LSG of levator avulsion (37.39±4.11) mm was greater than that of intact levator ani muscle (21.81±2.96) mm, and the difference was statistically significant (t=8.352, P<0.05). ConclusionsTUI and MRI are effective examinations to diagnose levator avulsion. LUG and LSG are good imaging parameters to evaluate the levator avulsion in postpartum women.