女性压力性尿失禁患者盆底肌形态改变的磁共振成像评价

目的 磁共振成像(MRI)技术探讨女性压力性尿失禁(SUI)患者盆底肌形态的改变.方法 自2006年1月至2008年6月间,21例SUI患者(尿失禁组)以及10例正常控尿成年女性(对照组)入组研究.所有对象均分别在平静状态以及屏气用力状态下行盆腔MRI扫描.分析尿失禁组和对照组两种状态下耻骨直肠肌厚度以及肛提肌裂隙面积的变化情况与SUI之间的关系.结果 无论在平静或屏气用力状态下,尿失禁组左、右侧耻骨直肠肌厚度均较对照组薄(均P<0.05).尿失禁组肛提肌裂隙多呈横径增宽的纵向椭圆形,平静状态下裂隙面积较对照组大(1893.44±218.44)mm2比(1661.86±206.62)mm2,P<0.05].尿失禁组阴道呈"H"形占33.3%(7/21),提示存在阴道侧壁损伤占66.7%(14/21);对照组阴道呈"H"形占80.0%(8/10).尿失禁组阴道侧壁损伤明显高于对照组(P<0.05).结论 女性压力性尿失禁患者左、右侧耻骨直肠肌厚度变薄,肛提肌裂隙明显增大.MRI在评价女性SUI患者的肛提肌形态改变的检测中结果可信,能为临床治疗提供明确信息.

Magnetic resonance imaging evaluation of altered pelvic floor musculature in females with stress urinary incontinence

Objective To investigate the altered pelvic floor musculature in females with stress urinary incontinence (SUI) using magnetic resonance imaging (MRI). Methods Between January 2006 and June 2008,21 patients with SUI in our hospital (SUI group) and 10 normal subjects (control group)were included in this study. Magnetic resonance imaging ( MRI ) scan was performed for the pelvis both under normal relaxing status and breath-holding status in two groups. The changes in thickness of puborectal muscle and area of levator ani muscle fissure related to SUI were examined. Results Under either of the two status (relaxing and breath-holding),the left and right puborectal muscles of the SUI patients were thinner than those of the controls (all P<0.05). The levator ani muscle fissure of the SUI group presented the form of vertical oval with widened horizontal diameter,and its area was larger than that of the control group (1893.44±218.44) mm2vs (1661.86+206.62) mm2,P<0.05]. 33.3% (7/21) of the SUI patients and 80.0%(8/10) of the controls had an H-shaped vagina,indicating injury of lateral wall of vagina in 66.7% ( 14/21 )of SUI patients with a significantly higher incidence compared with the control group (P<0.05).Conclusions Female SUI patients present thinner left and right puborectal muscles and obviously widened levator ani muscle fissure. MRI evaluation of morphological change of levator ani muscle in female patients with SUI can provide reliable information for clinical management of SUI.