女性盆腔脏器脱垂疾病数字化三维重建研究与空间坐标评估体系的建立

Female pelvic organ prolapse (FPOP) is one of the main diseases affecting the quality of life of middle aged and elderly women in non-neoplastic diseases. An aging population makes the incidence of this disease to increase year by year. Surgical operation is the main treatment. While the recurrence rate of classic repair surgery is high, the method of patch implantation reinforces the supporting force, which significantly reduce the recurrence rate. However, this method is costly and is associated with complications which may trigger new symptoms. As such, there is still no perfect surgical method. The main reason for this is that the assessment method of pelvic defects is crude and indirect, which results in the diagnosis of FPOP only representing external problems whereas, inner defected parts are not properly assessed. In recent years, research with the use of 2D and 3D MRI reconstructions on the anus levator muscle and ligament has become a hot topic. It found that the characteristic of the high resolution of soft tissue in the magnetic resonance imaging (MRI) has a big advantage in pelvic floor study. Our team commenced the study of 3D reconstruction technology based on the MRI datasets in 2009. We have mastered the most common, key technologies of MRI three-dimensional reconstruction. We have done research targeted on the reconstruction methods of the normal pelvis, viscera, ligaments, pelvic floor muscles. This project is aimed at 3D reconstruction of the whole pelvic base on static and dynamic MRI images from FPOP patients, and establish the corresponding space coordinates assessment system to do location and quantitative research of the pelvic viscera and its support structure, thus providing a FPOP diagnosis platform that is more precise, direct and comprehensive.

女性盆腔脏器脱垂（FPOP）是非肿瘤性疾病中影响中老年女性生活质量的主要疾病之一，人口老龄化使该病发病率逐年上升。手术是主要的治疗手段，经典修补手术复发率高，现代植入补片强化承托力的方法显著降低复发率，但费用高并发症多，可引发新的症状，故目前仍未找到完美的手术方法，原因之一是评估盆腔缺陷的方法粗糙、间接，导致FPOP的诊断仅反应表观，无法明确内在缺损部位。近年利用MRI进行二维和三维盆腔肛提肌、韧带等研究成为热点，发现MRI对软组织分辨率高的特点在盆底研究中有较大优势。本团队自2009年开始利用MRI进行三维重建技术的学习，掌握了MRI三维重建的常用和关键技术，针对正常人群骨盆、脏器、韧带、盆底肌肉等重建方法进行相关的研究。本课题旨在对FPOP进行全盆腔静态和动态下的三维重建，并建立相应的空间坐标评估体系对盆底脏器及支持结构进行定位量化研究，为FPOP的精确直接全面诊断提供平台。

盆腔器官脱垂（Pelvic organ prolapse ，POP）是影响中老年女性生活质量的主要疾病之一。传统的修复手术复发率高，主要原因在于对POP的盆底解剖认识不足且盆腔缺陷难以精确定位。MRI能清晰显示盆腔脏器及盆底结缔组织，二维MRI结合三维重建技术对POP的研究有重要意义。本研究纳入70例盆腔器官脱垂患者，通过探究POP女性静态与最大用力状态（Valsalva动作）数据采集方法、最佳成像序列、三维重建方法，成功构建动静态脏器及支持结构三维模型，分析其脏器、肌肉、韧带的结构特点，为临床医生提供参考，并结合三维空间坐标系个体化纠正骨盆倾斜移动，分析其在临床的应用。得出结论认为：①T2W_SSFSE是最大用力状态的最佳成像序列。②基于动静态MRI可构建盆腔器官及盆底结构动静态三维模型。③以耻骨联合下缘中点为坐标原点建立三维空间坐标系，可以个体化纠正骨盆倾斜移动，精确测量脏器的实际移动。④POP患者术前最大用力状态阴道前壁呈凹槽状，阴道后壁呈屈膝状，盆腔脏器向后下移动，术后脏器基本恢复正常位置。⑤POP患者静态肛提肌裂孔形态较非POP稍大，最大用力下肛提肌裂孔横径、前后径显著增大，表明肛提肌支撑力减弱与POP的发生密切相关。⑥右侧骶棘韧带距坐骨棘水平2.81cm处是POP单侧骶棘韧带固定术的最佳悬吊点。⑦POP骶韧带较非POP更长，更薄。⑧临床POP-Q C-D点评估宫颈过长明显大于MRI的测量的宫颈长度，阴道前壁脱垂越明显，差别越明显，阴道后壁脱垂越明显，差别越小。⑨盆底超声采用30°参考线进行POP分度与临床POP-Q一致性更高。⑩基于三维空间坐标个体化纠正骨盆倾斜移动后测量的尿道分段移动度是区分膀胱脱垂是否合并压力性尿失禁的较好指标。⑪基于三维空间坐标个体化纠正骨盆倾斜移动，发现阴道前壁脱垂伴随阴道顶端显著下降，直肠膨出合并会阴体显著下降。.通过以上结论，成功构建POP在体动、静态盆腔脏器与支持结构三维模型，了解解剖差异，有利于POP术前评估，为患者个性化设计盆底重建手术提供客观依据，且通过术后三维模型可以初步评估手术疗效。