基于3.0-T磁共振的女性盆底功能障碍研究

发布时间：2018-12-14 22:37

【摘要】：盆底功能障碍又称盆底缺陷或盆底支持组织松弛,是各种原因导致盆底支持结构薄弱,进而盆腔脏器移位而导致的功能异常,主要包括压力性尿失禁和盆腔器官脱垂。盆底功能障碍是女性中十分常见的疾病,其发病率随年龄的增长而增加,严重影响患者的身体健康和生活质量。及时的诊断和准确完整的评估盆底功能障碍程度和范围,是正确选择治疗处理措施,改善患者预后的前提条件。盆底功能障碍的诊断主要依据患者的临床表现、病史、体格检查以及各项辅助检查等。磁共振由于具有良好的软组织对比度、无电离辐射、可多平面成像等诸多优势,在女性盆底功能障碍的诊断和研究中占有重要地位。由于既往诸多研究所采用的设备各不相同,研究的侧重点各异,盆底功能的磁共振检查方法尚未统一规范。3.0T磁共振设备的出现,使我们能建立一站式的磁共振检查流程,设计合理的快速动态成像序列,获得更清晰的软组织影像和更快的时间分辨率,全方位分析女性盆底的解剖结构和功能异常,为临床的诊断和治疗提供更完整、准确的信息。材料与方法：本研究分为3部分。第1部分：建立3.0T磁共振盆底功能检查方法。共20名病例纳入研究,设计静态和动态两部分磁共振扫描序列,其中动态扫描序列采用单次激发快速回波T2WI序列,分为静息、提肛、排便和最大用力四个时相。采用组内相关系数法分析磁共振动态影像定量测量的可靠性。第2部分：分析女性盆底功能障碍3.0T磁共振表现及与X线排便造影的对比研究。共230例病例纳入研究,分析和记录膀胱脱垂、子宫脱垂、肠疝、直肠前膨、直肠套叠和直肠脱垂影像表现；以X线排便造影为标准,计算磁共振诊断直肠前膨和直肠套叠的敏感性和特异性。第3部分：评估肛提肌缺损程度及与盆底松弛的相关性。采用采用DeLancey提出的评分方法对230例病例耻骨直肠肌进行分度；采用HMO系统定量测量盆底松弛程度。采用Spearman法分析耻骨直肠肌分度与盆底松弛分级的相关性。结果： 1.3.0T磁共振静态及动态影像清晰符合诊断要求,动态影像的定量测量具有良好的可重复性。 2.230例患者中,磁共振表现为膀胱脱垂38例(16.5%),子宫脱垂34例(14.8%),肠疝3例(1.3%),其中小肠合并肠系膜疝2例,乙状结肠疝1例；直肠套叠28例(12.2%),直肠脱垂0例。在磁共振矢状位动态排便相诊断直肠前膨108例(46.9%)。X线排便造影表现为直肠套叠37例(16.1%),直肠前膨145例(63.0%)。以X线排表造影作为金标准,磁共振诊断直肠前膨敏感性73.1%,特异性97.6%(表5)；诊断直肠套叠的敏感性为64.9%,特异性为97.9%(表6)。 3.肛提肌损伤分度为正常85例,轻度102例,重度43例；HMO分级盆底松弛为0级(正常)7例,1级121例,3级89例,3级13例。两者之间的Spearman相关系数为0.274,P0.001。结论： 1.利用3.0T磁共振可建立静态扫描与以快速成像序列为基础的动态扫描相结合的一站式女性盆底功能障碍影像检查方法。 2.基于女性盆底动态扫描序列的磁共振定量测量方法具有良好的操作性和可重复性。 3.3.0T磁共振静动态影像可清楚地显示女性盆底功能障碍各类解剖结构异常及功能障碍；但直肠前膨及直肠套叠的检出率低于常规X线排便造影。 4.静动态扫描相结合的磁共振影像可以定量的评估耻骨直肠肌损伤情况及盆底松弛程度；盆底功能障碍患者肛提肌损伤分度与盆底松弛分级具有显著相关性,肛提肌损伤可能是导致盆底松弛并进一步引发盆底功能障碍的重要原因。
[Abstract]:The pelvic floor dysfunction, also known as pelvic floor defect or pelvic floor support tissue relaxation, is a result of the weak support structure of the pelvic floor and the abnormal function caused by pelvic organ displacement, mainly including stress urinary incontinence and pelvic organ prolapse. pelvic floor dysfunction is a very common disease in women, and its incidence increases with age, which seriously affects the health and quality of life of the patients. timely diagnosis and accurate and complete assessment of the degree and extent of the pelvic floor dysfunction is a prerequisite for proper selection of treatment and improvement of the patient's prognosis. The diagnosis of pelvic floor dysfunction is based on the clinical features, medical history, physical examination and various auxiliary examinations of the patients. Magnetic resonance plays an important role in the diagnosis and study of female pelvic floor dysfunction due to the advantages of good soft tissue contrast, no ionizing radiation, and multi-plane imaging. Due to the different equipment used by the previous research institutes, the focus of the study is different, and the magnetic resonance examination method of the basin bottom function has not been standardized. The appearance of the 3.0T magnetic resonance equipment makes us establish one-stop magnetic resonance inspection process, and design a reasonable fast dynamic imaging sequence. obtaining a clearer soft tissue image and a faster time resolution, and comprehensively analyzing the anatomical structure and the functional abnormality of the female pelvic floor, and providing more complete and accurate information for clinical diagnosis and treatment. Materials and parties Method: This study is divided into Part 3. Part 1: Establishment of a 3. 0T magnetic resonance basin bottom function test A total of 20 cases were included in the study to design a static and dynamic two-part magnetic resonance scan sequence, in which the dynamic scan sequence was a single-shot fast-echo T2WI sequence, which was divided into the rest, the proctocele, the defecation and the maximum force. Method for quantitative measurement of dynamic image of magnetic resonance by intra-group correlation coefficient method Reliability. Part 2: Analysis of the 3. 0T MR performance of the female pelvic floor and the contrast with the X-ray defecation Comparative study. A total of 230 cases were included in the study, analysis and recording of bladder prolapse, uterine prolapse, intestinal hernia, prerectal, straight-intussusception, and rectal prolapse; and the sensitivity and sensitivity of magnetic resonance to prerectal and straight intussusception were calculated using X-ray defecation as a standard. Specificity. Part 3: Evaluation of the degree of defect of the levator and the relaxation of the pelvic floor. Correlations: The retropubic muscles of 230 cases were divided by using the scoring method proposed by DeLancey, and the bottom of the pelvic floor was measured by the HMO system. To evaluate the degree of relaxation. The method of Spearman's method is used to analyze the grading of the subpubic and pelvic muscles. correlation Results: 1. 3. 0T magnetic resonance and dynamic images were clearly in accordance with the diagnostic requirements, and the quantitative measurement of the dynamic images was Good reproducibility. Among the 230 patients, the magnetic resonance was 38 (16. 5%) of the bladder prolapse, 34 (14. 8%) of the prolapse of the uterus, 3 (1.3%) of the intestinal hernia, 2 of the small intestine, 1 case of the sigmoid hernia, and 28 (12. 2) of the direct intussusception. A total of 108 cases of rectal prolapse (46. 9%) were diagnosed by the dynamic defecation in the sagittal position of the rectum. The sensitivity of MRI in the diagnosis of intussusception was 60.9% and the specificity was 64.9%. 97. 9% (Table 6). 3. The injury index of the levator is normal in 85 cases, mild in 102 cases, and severe in 43 cases; the level of the HMO grading basin is 0 (normal) in 7 cases, and the grade 1 is 121 cases. There were 89 cases in grade 3 and 13 in grade 3. The Spearman correlation coefficient between the two was 0.. 27 4, P0.001. Conclusion: 1. The static scan can be established by using the 3.0T magnetic resonance, and a one-stop combined with the fast imaging sequence can be established. a method of image examination for women's pelvic floor dysfunction. 2. Magnetic resonance quantification based on the dynamic scanning sequence of the pelvic floor The method has good operability and repeatability. and the detection rate of the straight intussusception is lower than that of the conventional X-ray defecation contrast. There is a significant correlation between the index of the injury of the levator muscle and the grading of the pelvic floor, and the injury of the levator's muscle may be the result
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R711.5

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