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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2018, Vol. 15 ›› Issue (10) : 790 -795. doi: 10.3877/cma.j.issn.1672-6448.2018.10.013

所属专题： 文献；

妇产科超声影像学

断层超声成像及磁共振成像技术对产后女性肛提肌撕脱的评价
严雨霖1, 窦超然1, 李勤1, 郗艳2, 王霞1, 胡兵1, 应涛1,†()   
  1. 1. 200233　上海交通大学附属第六人民医院超声医学科　上海市超声医学研究所
    2. 200233　上海交通大学附属第六人民医院放射科
  • 收稿日期:2017-03-12 出版日期:2018-10-01
  • 通信作者: 应涛

A preliminary application of tomographic ultrasound imaging and magnetic resonance imaging in evaluating levtor avulsion in postpartum women

Yulin Yan1, Chaoran Dou1, Qin Li1, Yan Xi2, Xia Wang1, Bing Hu1, Tao Ying1,†()   

  1. 1. Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People′s Hospital, Shanghai 200233, China
    2. Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People′s Hospital, Shanghai 200233, China
  • Received:2017-03-12 Published:2018-10-01
  • Corresponding author: Tao Ying
  • About author:
    Corresponding author: Ying Tao, Email:
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引用本文：

严雨霖, 窦超然, 李勤, 郗艳, 王霞, 胡兵, 应涛. 断层超声成像及磁共振成像技术对产后女性肛提肌撕脱的评价[J/OL]. 中华医学超声杂志（电子版）, 2018, 15(10): 790-795.

Yulin Yan, Chaoran Dou, Qin Li, Yan Xi, Xia Wang, Bing Hu, Tao Ying. A preliminary application of tomographic ultrasound imaging and magnetic resonance imaging in evaluating levtor avulsion in postpartum women[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(10): 790-795.

目的

分别采用盆底三维超声断层超声成像技术（TUI）和盆底磁共振成像技术（MRI）研究肛提肌尿道间隙（LUG）和肛提肌耻骨间隙（LSG）在产后肛提肌撕脱女性的变化，探讨LUG、LSG在评价产后肛提肌撕脱情况的应用价值。

方法

选取2015年12月至2016年10月在上海交通大学附属第六人民医院就诊的经阴道分娩的产后女性，采用经会阴三维超声随访，筛选出肛提肌撕脱女性20例，选择未育组女性20例作为对照组。采用TUI获得盆底的断层超声图像，在最小盆膈裂孔及其上下各一个平面测量两侧的LUG，取均值。采用MRI获得盆底薄层图像，并重建出盆底结构三维立体模型，在三维模型上测量LSG，两侧分别测量。

结果

对照组肛提肌均无撕脱，LUG值为（17.80±1.39）mm，LSG值为（19.71±1.94）mm。产后撕脱组28侧肛提肌撕脱，12侧无肛提肌撕脱。撕脱侧LUG值明显大于无撕脱侧［（27.94±2.53）mm vs （19.78±1.35）mm］，差异有统计学意义（t=8.352，P<0.05）；撕脱侧LSG值明显大于无撕脱侧［（37.39±4.11）mm vs （21.81±2.96）mm］，差异有统计学意义（t=8.352，P<0.05）。

结论

TUI与MRI均可用于诊断肛提肌撕脱，LUG与LSG是有效的评估肛提肌撕脱的影像学参数。

关键词: 超声检查, 磁共振成像, 肛提肌尿道间隙, 肛提肌耻骨间隙
Objective

To study the changes of levator-urethra gap (LUG) by tomographic ultrasound imaging (TUI) and levator-symphysis gap (LSG) by magnetic resonance imaging (MRI) in postpartum females.

Methods

Twenty postpartum women with levator avulsion and 20 nulliparas were examined by TUI and LUGs were measured on the slice 0,1 and 2. Magnetic resonance imaging scans of levator ani muscle were obtained in thin slices. Then a three-dimensional model of the levator ani muscle was created by Mimics software. LSGs were measured on three-dimensional models.

Results

None levator avulsion were found in the images of 20 nulliparas. LUG was (17.80±1.39) mm and LSG was (19.71±1.94) mm. The levator avulsions were found in 28 sides, and 12 sides were without levator avulsion. The LUG of levator avulsion (27.94±2.53) mm was greater than that of intact levator ani muscle (19.78±1.35) mm, and the difference was statistically significant (t=8.352, P<0.05). The LSG of levator avulsion (37.39±4.11) mm was greater than that of intact levator ani muscle (21.81±2.96) mm, and the difference was statistically significant (t=8.352, P<0.05).

Conclusions

TUI and MRI are effective examinations to diagnose levator avulsion. LUG and LSG are good imaging parameters to evaluate the levator avulsion in postpartum women.

Key words: Ultrasonography, Magnetic resonance imaging, Levator-urethra gap, Levator-symphysis gap
图1 肛提肌双侧撕脱断层超声成像图像。红线为在0、1、2层面上测量肛提肌尿道间隙，分别测量左右断层超声成像表现为0、1、2层可见肛提肌与同侧耻骨支内侧缘之间肌肉回声不连续，阴道壁向外突出
图2 肛提肌双侧撕脱三维模型。黑线为三维模型上测量肛提肌耻骨间隙，分别测量左右三维图像上灰色结构为盆底骨性结构，红色为肛提肌。图像上可见肛提肌与同侧耻骨支内侧缘之间分离
图3~5 为左侧撕脱的断层超声成像和MRI及三维模型的对比图
图6~8 为右侧撕脱的断层超声成像和MRI及三维模型的对比图
图9~11 为双侧撕脱的断层超声成像和MRI及三维模型的对比图
表1 未育组和产后组LUG和LSG比较（mm）
组别 例数 LUG LSG
未育组 40 17.80±1.34 19.71±1.94
产后组 ? ? ?
? 肛提肌撕脱侧 28 27.94±2.53a 37.39±4.11a
? 肛提肌无撕脱侧 12 19.78±1.35bc 21.81±2.96bc
F值 ? 82.54 140.20
P值 ? <0.0001 <0.0001
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