MRI评估宫颈癌子宫根治术后患者肛提肌长期变化

目的 采用MRI评估宫颈癌子宫根治术(RH)后1、5年患者肛提肌变化。方法 前瞻性纳入30例接受RH的宫颈癌患者,分别于术前、术后1年及5年采集静息态及最大瓦尔萨尔瓦动作下盆底MRI,重建骨盆及肛提肌三维模型;测量并比较不同时间点肛提肌裂孔横径(LH-W)、前后径(LH-L)、肛提肌板角度(LPA)、肛提肌体积(LVOL),双侧肛提肌与耻骨联合下缘间距(LSG)、髂尾肌角度(ICA)及厚度(ICT)、耻骨直肠肌厚度、M线及H线长度的差异。结果 静息态及最大瓦尔萨尔瓦动作下,双侧ICT及耻骨直肠肌厚度逐渐变薄、M线逐渐延长,各时间点差异均有统计学意义(P均＜0.05)。术后1年,静息态下LVOL较术前减小(P＜0.05);最大瓦尔萨尔瓦动作下,双侧ICA及LPA均较术前增大而LVOL减小(P均＜0.05)。结论 宫颈癌RH术后患者髂尾肌、耻骨直肠肌逐渐萎缩变薄,盆底支持能力逐渐减弱。

MRI for evaluation on long-term changes of levator ani muscle in cervical cancer patients after radical hysterectomy

Objective To observe changes of levator ani muscle in cervical cancer patients 1 year and 5 years after radical hysterectomy (RH) with MRI. Methods Totally 30 cervical cancer patients after RH were prospectively enrolled. MR images of pelvic floor under resting-state and the maximum Valsalva maneuver were acquired before, 1 year and 5 years after RH, respectively, and three-dimensional models of pelvis and levator ani muscle were reconstructed. The width of levator hiatal (LH-W), length of levator hiatal (LH-L), levator plate angle (LPA), levator volume (LVOL), as well as the distance between symphysis and levator sling muscle (LSG), iliococcygeus angle (ICA), left/right iliococcygeus thickness (ICT), thickness of puborectalis, the length of M-line and H-line were measured and compared among different time points. Results Under resting-state and the maximum Valsalva maneuver, bilateral ICT and the thickness of puborectalis gradually became thinner, and the M-line gradually lengthened, and significant differences were found among all time points (all P<0.05).One year after RH, under resting-state, LVOL decreased 1 year compared with preoperative (P<0.05), while under the maximum Valsalva maneuver, bilateral ICA and LPA increased furtherly and LVOL decreased (all P<0.05). Conclusion The iliococcygeus and puborectalis gradually atrophied and thinned in cervical cancer patients after RH, while the pelvic floor support ability gradually became weakened.