目的 通过MRI探究广泛性全子宫切除术(Radical hysterectomy,RH)前、术后1年及5年阴道轴向变化。 方法 选取2015年10月至2016年10月在南方医科大学南方医院接受RH的宫颈癌患者，分别于术前、术后1年及5年行MRI共纳入30例。通过Mimics 23.0软件将术前、后骨盆及阴道三维重建并置于同一空间，以术前、术后1年及5年阴道受力点为P1~P3，测量阴道长度、P1~P3处阴道夹角及坐标。 结果 P2较P1角度增大（19.99±4.26）°、术后1年阴道缩短（5.55±0.6）cm，P3较P1角度增大（24.50±4.33）°、术后5年阴道缩短（5.95±1.13）cm，P3较P2角度增大（4.51±0.33）°、术后5年较1年阴道缩短（0.42±0.53）cm（P均<0.05）；P1坐标（3.19±0.69，1.59±0.52），P2（2.52±0.38，0.94±0.87），P3（2.39±0.46，0.69±0.59）。 结论 RH术后阴道轴向夹角逐渐变钝、前倾，受力点向前更靠近耻骨联合、向下更靠近阴道口，这可能是其术后长期较少发生盆腔脏器脱垂原因之一。
Abstract
Objective To explore the axial changes of vagina before, 1 year and 5 years after radical hysterectomy (RH) by MRI visualization. Methods A total of 30 cervical cancer patients who received RH in Nanfang Hospital of Southern Medical University from October 2015 to October 2016 underwent pelvic MRI examination 1 year and 5 years after operation respectively were included. Mimics 23.0 software was used to reconstruct the pelvis and vagina, the preoperative and posterior pelvis and vagina were matched and corrected by pelvic tilt correction system and placed in the same space. The axial stress points of vagina were named P1~P3 before surgery, 1 year and 5 years after surgery, respectively. The length of vagina, the angle and coordinates of upper and lower sections of P1~P3 were measured, and the differences of axial changes of vagina after operation were compared. Results The angle of P2 was (19.99±4.26) °higher than that of P1 and the vagina shortened by (5.55±0.6) cm one year after operation, The angle of P3 was (24.50±4.33)° higher than that of P1 and the vagina shortened by (5.95±1.13) cm five years after operation. The angle of P3 was (4.51±0.33) ° higher than that of P2, and the vagina was shortened (0.42±0.53) cm 5 years after surgery compared with 1 year after surgery (P<0.05). Stress point coordinates of P1 (3.19±0.69, 1.59±0.52), P2 (2.52±0.38, 0.94±0.87), P3 (2.39±0.46, 0.69±0.59). Conclusions After RH, the angle between the upper and lower segments of the vagina is gradually blunt and forward, and the force point is closer to the pubic symphysis in the forward direction and to the vaginal opening in the downward direction, which may be one of the reasons for the long-term rare occurrence of pelvic organ prolapse.
关键词
广泛性全子宫切除术； /
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MRI；阴道轴向； /
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三维可视化研究； /
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骨盆倾斜校正
Key words
Radical hysterectomy; /
MRI; /
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Vaginal axial direction; /
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3D visualization research; /
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Pelvic tilt correction
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参考文献
[1] Wang S, Wang R, Wen H, et al. Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy[J]. Neurourol Urodyn, 2021, 40(1):483-492. DOI: 10.1002/nau.24587.
[2] Brennen R, Lin K, Denehy L, et al. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review[J]. Phys Ther, 2020, 100(8):1357-1371. DOI: 10.1093/ptj/pzaa081.
[3] Selcuk S, Cam C, Asoglu MR, et al. Effect of simple and radical hysterectomy on quality of life - analysis of all aspects of pelvic floor dysfunction[J]. Eur J Obstet Gynecol Reprod Biol, 2016, 198:84-88. DOI: 10.1016/j.ejogrb.2016.01.008.
[4] Luo J, Betschart C, Ashton-Miller J A, et al. Quantitative analyses of variability in normal vaginal shape and dimension on MR images[J]. Int Urogynecol J, 2016, 27(7):1087-95. DOI: 10.1007/s00192-016-2949-0.
[5] 刘萍, 唐连. 磁共振成像盆底三维重建的方法及意义[J]. 中国实用妇科与产科杂志, 2017, 33(10):1014-1018. DOI:10.19538/j.fk2017100 107.
[6] Juliato CRT, Santos-Junior LC, de Castro EB, et al. Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial[J]. Neurourol Urodyn, 2019, 38(4):1142-1151. DOI: 10.1002/nau.23970.
[7] 卢逸嘉, 陈春林, 刘萍. 广泛性子宫切除术与全子宫切除术对盆底影响的研究进展[J].妇产与遗传(电子版), 2020, 10(01):55-59. DOI:10. 3868/j. issn. 2095 - 1558. 2020. 01. 012.
[8] 姜文轩, 陈春林, 刘萍, 等. 广泛性子宫切除术后盆腔器官位置改变的静动态MRI评估[J].中华妇产科杂志, 2020, 55(06):408-411. DOI：10.3760/cma.j.cn112141-20191218-00679.
[9] 陈兰, 陈春林, 刘萍, 等.盆底功能正常的未育青年女性静息状态下膀胱尿道的三维解剖[J].中国临床解剖学杂志, 2021, 39(1):31-36. DOI：10.13418/j.issn.1001-165x.2021.01.007.
[10] Reiner CS, Williamson T, Winklehner T, et al. The 3D Pelvic Inclination Correction System (PICS): a universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP)[J]. Comput Med Imaging Graph, 2017, 59:28-37. DOI: 10.1016/j.compmedimag.2017.05.005.
[11] Betschart C, Chen L, Ashton-Miller JA, et al. On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic inclination correction system[J]. Int Urogynecol J, 2013, 24(9):1421-1428. DOI: 10.1007/s00192-013-2100-4.
[12] Sinex DCE, Bowen ST, Kashkoush A, et al. The establishment of a 3D anatomical coordinate system for defining vaginal axis and spatial position[J]. Comput Methods Programs Biomed, 2021, 208:106-175. DOI: 10.1016/j.cmpb.2021.106175.
[13] Lee DD, Siegelman ES, Chua WY, et al. Comparison of vaginal axis in women who have undergone hysterectomy versus women with an intact uterus[J]. Female Pelvic Med Reconstr Surg, 2019, 25(4):313-317. DOI: 10.1097/SPV.0000000000000557.
[14] Kim-Fine S, Antosh DD, Balk EM, et al. Relationship of postoperative vaginal anatomy and sexual function: a systematic review with meta-analysis[J]. Int Urogynecol J, 2021, 32(8):2125-2134. DOI: 10.1007/s00192-021-04829-4.
[15] Collins AF, Doyle PJ, Vilasagar S, et al. Utility of anterior vaginal wall length measurement in vaginal reconstructive surgery[J]. Int Urogynecol J, 2017, 28(8):1197-1200. DOI: 10.1007/s00192-016-3247-6.
基金
广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目（LC2016ZD019）；南方医科大学南方医院“临床研究专项”（2018CR030）
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