磁共振成像动态扫描诊断分娩后盆腔器官脱垂的应用价值

Application value of dynamic magnetic resonance imaging in diagnosis of pelvic organ prolapse after delivery

摘要:

目的 探讨磁共振成像（MRI）动态扫描在女性盆底损伤中的诊断价值。方法 前瞻性选取2019年1月—2019年9月金华市中心医院经阴道分娩初产妇、剖宫产初产妇、未孕未产女性，每组30例。经阴道分娩组和剖宫产组产妇MRI动态扫描前行盆腔器官脱垂定量分度法（POP-Q）评估，评估后3组受试者均行MRI动态扫描。测量3组受试者盆腔器官至耻骨尾骨线（PCL）的距离，同时计算盆腔器官活动度，采用单因素方差分析比较3组盆腔器官至PCL距离及盆腔器官活动度的差异，并比较经阴道分娩组和剖宫产组产妇MRI动态扫描与POP-Q评估脱垂程度的一致性。结果 POP-Q评估发现4例前盆腔脱垂合并中盆腔脱垂产妇，MRI动态扫描也发现该4例产妇存在脱垂，与POP-Q评估符合率为100%。MRI动态扫描还发现10例经阴道分娩产妇和1例剖宫产产妇的前盆腔I度脱垂，1例经阴道分娩产妇的中盆腔I度脱垂，该结果在POP-Q评估中未发现。MRI动态扫描结果显示，经阴道分娩组前盆腔脱垂发生率高于剖宫产组（46.7% VS 3.0%，P <0.05），中盆腔脱垂发生率在两组间差异无统计学意义（16.7% VS 0.0%，P >0.05）。产妇均未发现两种分娩方式后盆腔脱垂。静息态下3组盆腔器官至PCL的距离差异无统计学意义（P >0.05）。最大腹压状态下3组盆腔器官至PCL的距离、盆腔器官活动度比较，差异有统计学意义（P <0.05）。经阴道分娩组最大腹压状态下盆腔器官至PCL距离小于剖宫产组和未孕未产组（P <0.0167），盆腔器官活动度大于剖宫产组和未孕未产组（P <0.0167），而剖宫产组与未孕未产组间差异无统计学意义（P >0.0167）。结论 MRI动态扫描早期诊断分娩后盆腔器官脱垂较POP-Q评估更具优势，并能量化盆底损伤程度，确定盆底损伤部位，为盆底康复方案的制订提供更加精细化的临床信息。

Abstract:

Objective To investigate the diagnostic value of dynamic magnetic resonance imaging (MRI) in female pelvic floor injury.Methods From January 2019 to September 2019, subjects were prospectively selected from Jinhua Central Hospital, including vaginal delivery primiparas, cesarean section primiparas, and non pregnant women, with 30 cases in each group. Before the dynamic MRI scanning of pregnant women in vaginal delivery group and cesarean section group, the quantitative graduation method of pelvic organ prolapse (POP-Q) was evaluated. After the evaluation, the subjects in the three groups underwent dynamic MRI scanning. The distance between pelvic organs and pubococcinate line (PCL) under MRI Dynamic scanning was measured, and the activity of pelvic organs was calculated. The differences of the distance between pelvic organs and PCL and the activity of pelvic organs in the three groups were compared by one-way ANOVA, and the consistency between the degree of prolapse diagnosed by MRI dynamic scanning in transvaginal delivery group and cesarean section group and the degree of prolapse evaluated by POP-Q was analyzed.Results POP-Q found anterior pelvic prolapse combined with middle pelvic prolapse in 4 primipara. The dynamic MRI showed that the 4 primipara suffered prolapse, with the POP-Q coincidence rate of 4/4. Dynamic MRI found anterior pelvic prolapse degree of I in 10 vaginal delivery primipara and 1 cesarean section primipara with normal POP-Q quantitation and middle pelvic prolapse degree of I in 1 vaginal delivery primipara with normal POP-Q quantitation. The results of dynamic MRI prolapse evaluation showed that the incidence of anterior pelvic prolapse in vaginal delivery group was higher than that in cesarean section group (46.7% VS 3.0%, P < 0.05), and there was no significant difference in the incidence of middle pelvic prolapse between the two groups (16.7% VS 0.0%, P > 0.05); no posterior pelvic prolapse was found in both delivery modes. There was no significant difference in distance from the pelvic organ to PCL among the three groups during rest Valsalva (P > 0.05). There were significant differences in distance from the pelvic organ to PCL and the activity of the pelvic organ among the three groups during maximal valsalva (P < 0.05). The distance from the pelvic organ to PCL during maximal valsalva were significantly lower than those in the cesarean section group and the nulliparous group (P < 0.0167), and the activity of the pelvic organ in the vaginal delivery group during maximal valsalva were significantly higher than those in the cesarean section group and the nulliparous group (P < 0.0167), but there was no significant difference between the cesarean section group and the nulliparous group (P > 0.0167).Conclusions Compared with POP-Q, dynamic MRI has more advantages in the early diagnosis of pelvic organ prolapse after delivery. At the same time, it could quantify the degree of pelvic floor injury, locate pelvic floor injury, and provide more refined clinical information for the formulation of pelvic floor rehabilitation programs.