【摘要】：盆底功能障礙又稱盆底缺陷或盆底支持組織松弛,是各種原因?qū)е屡璧字С纸Y(jié)構(gòu)薄弱,進(jìn)而盆腔臟器移位而導(dǎo)致的功能異常,主要包括壓力性尿失禁和盆腔器官脫垂。盆底功能障礙是女性中十分常見的疾病,其發(fā)病率隨年齡的增長(zhǎng)而增加,嚴(yán)重影響患者的身體健康和生活質(zhì)量。及時(shí)的診斷和準(zhǔn)確完整的評(píng)估盆底功能障礙程度和范圍,是正確選擇治療處理措施,改善患者預(yù)后的前提條件。盆底功能障礙的診斷主要依據(jù)患者的臨床表現(xiàn)、病史、體格檢查以及各項(xiàng)輔助檢查等。磁共振由于具有良好的軟組織對(duì)比度、無(wú)電離輻射、可多平面成像等諸多優(yōu)勢(shì),在女性盆底功能障礙的診斷和研究中占有重要地位。由于既往諸多研究所采用的設(shè)備各不相同,研究的側(cè)重點(diǎn)各異,盆底功能的磁共振檢查方法尚未統(tǒng)一規(guī)范。3.0T磁共振設(shè)備的出現(xiàn),使我們能建立一站式的磁共振檢查流程,設(shè)計(jì)合理的快速動(dòng)態(tài)成像序列,獲得更清晰的軟組織影像和更快的時(shí)間分辨率,全方位分析女性盆底的解剖結(jié)構(gòu)和功能異常,為臨床的診斷和治療提供更完整、準(zhǔn)確的信息。 材料與方法： 本研究分為3部分。第1部分：建立3.0T磁共振盆底功能檢查方法。共20名病例納入研究,設(shè)計(jì)靜態(tài)和動(dòng)態(tài)兩部分磁共振掃描序列,其中動(dòng)態(tài)掃描序列采用單次激發(fā)快速回波T2WI序列,分為靜息、提肛、排便和最大用力四個(gè)時(shí)相。采用組內(nèi)相關(guān)系數(shù)法分析磁共振動(dòng)態(tài)影像定量測(cè)量的可靠性。第2部分：分析女性盆底功能障礙3.0T磁共振表現(xiàn)及與X線排便造影的對(duì)比研究。共230例病例納入研究,分析和記錄膀胱脫垂、子宮脫垂、腸疝、直腸前膨、直腸套疊和直腸脫垂影像表現(xiàn)；以X線排便造影為標(biāo)準(zhǔn),計(jì)算磁共振診斷直腸前膨和直腸套疊的敏感性和特異性。第3部分：評(píng)估肛提肌缺損程度及與盆底松弛的相關(guān)性。采用采用DeLancey提出的評(píng)分方法對(duì)230例病例恥骨直腸肌進(jìn)行分度；采用HMO系統(tǒng)定量測(cè)量盆底松弛程度。采用Spearman法分析恥骨直腸肌分度與盆底松弛分級(jí)的相關(guān)性。 結(jié)果： 1.3.0T磁共振靜態(tài)及動(dòng)態(tài)影像清晰符合診斷要求,動(dòng)態(tài)影像的定量測(cè)量具有良好的可重復(fù)性。 2.230例患者中,磁共振表現(xiàn)為膀胱脫垂38例(16.5%),子宮脫垂34例(14.8%),腸疝3例(1.3%),其中小腸合并腸系膜疝2例,乙狀結(jié)腸疝1例；直腸套疊28例(12.2%),直腸脫垂0例。在磁共振矢狀位動(dòng)態(tài)排便相診斷直腸前膨108例(46.9%)。X線排便造影表現(xiàn)為直腸套疊37例(16.1%),直腸前膨145例(63.0%)。以X線排表造影作為金標(biāo)準(zhǔn),磁共振診斷直腸前膨敏感性73.1%,特異性97.6%(表5)；診斷直腸套疊的敏感性為64.9%,特異性為97.9%(表6)。 3.肛提肌損傷分度為正常85例,輕度102例,重度43例；HMO分級(jí)盆底松弛為0級(jí)(正常)7例,1級(jí)121例,3級(jí)89例,3級(jí)13例。兩者之間的Spearman相關(guān)系數(shù)為0.274,P0.001。 結(jié)論： 1.利用3.0T磁共振可建立靜態(tài)掃描與以快速成像序列為基礎(chǔ)的動(dòng)態(tài)掃描相結(jié)合的一站式女性盆底功能障礙影像檢查方法。 2.基于女性盆底動(dòng)態(tài)掃描序列的磁共振定量測(cè)量方法具有良好的操作性和可重復(fù)性。 3.3.0T磁共振靜動(dòng)態(tài)影像可清楚地顯示女性盆底功能障礙各類解剖結(jié)構(gòu)異常及功能障礙；但直腸前膨及直腸套疊的檢出率低于常規(guī)X線排便造影。 4.靜動(dòng)態(tài)掃描相結(jié)合的磁共振影像可以定量的評(píng)估恥骨直腸肌損傷情況及盆底松弛程度；盆底功能障礙患者肛提肌損傷分度與盆底松弛分級(jí)具有顯著相關(guān)性,肛提肌損傷可能是導(dǎo)致盆底松弛并進(jìn)一步引發(fā)盆底功能障礙的重要原因。
[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
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R711.5

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