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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 273 -277. doi: 10.3877/cma.j.issn.2095-3224.2021.03.009

论著

磁共振对难治性排便障碍型便秘患者盆底裂孔改变的研究
张辉1, 高荣青2, 王志民3,†(), 陈璐4, 武国亮3, 张波3   
  1. 1. 253700　德州，庆云县人民医院
    2. 261042　潍坊，潍坊医学院临床医学院
    3. 250014　济南，山东第一医科大学第一附属医院普通外科
    4. 250011　济南，山东中医药大学附属医院麻醉科
  • 收稿日期:2020-08-25 出版日期:2021-06-25
  • 通信作者: 王志民
  • 基金资助:
    济南市科技发展计划(201907067)

MRI study of pelvic floor hiatus in patients with intractable defecation constipation

Hui Zhang1, Rongqing Gao2, Zhimin Wang3(), Lu Chen4, Guoliang Wu3, Bo Zhang3   

  1. 1. Qingyun County People's Hospital, Dezhou 253000, China
    2. Clinical Medical College of Weifang Medical University, Weifang 261042, China
    3. Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Ji'nan 250014, China
    4. Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan 250011, China
  • Received:2020-08-25 Published:2021-06-25
  • Corresponding author: Zhimin Wang
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张辉, 高荣青, 王志民, 陈璐, 武国亮, 张波. 磁共振对难治性排便障碍型便秘患者盆底裂孔改变的研究[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(03): 273-277.

Hui Zhang, Rongqing Gao, Zhimin Wang, Lu Chen, Guoliang Wu, Bo Zhang. MRI study of pelvic floor hiatus in patients with intractable defecation constipation[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(03): 273-277.

目的

探讨磁共振下难治性排便障碍型便秘患者在静息和力排期盆底裂孔的改变。

方法

前瞻性选取山东第一医科大学附属第一医院收治的难治性排便障碍型便秘患者60例（观察组），并同期招募37名健康志愿者（对照组）。分别对两组研究对象在静息和力排期进行盆底磁共振扫描检查，比较两组盆底裂孔的横径（LH-W）、纵径（LH-L）、盆底裂孔后角的大小（LH-PA）、盆底裂孔纵轴偏离中心位置的距离（d-LHVC）。

结果

观察组与对照组在静息状态下盆底裂孔的横径（LH-W）、纵径（LH-L）分别为［（2.64±1.89）cm、（2.59±2.44）cm；（7.35±2.52）cm、（6.82±2.07）cm］，两者比较差异无统计学意义（t=0.763，0.39；P＞0.05）；观察组与对照组在力排状态盆底裂孔的横径（LH-W）、纵径（LH-L）分别为［（3.37±2.26）cm、（4.11±3.84）cm；（6.64±2.29）cm、（5.54±1.84）cm］，两者比较差异有统计学意义（t=-6.11，9.71；P＜0.05）。观察组与对照组在静息状态下盆底裂孔后角（LH-PA）分别为［（48.57±5.23）°、（45.12±6.28）°］，两者比较差异无统计学意义（t=2.58，P＞0.05）。观察组与对照组在力排状态下盆底裂孔后角（LH-PA）分别为［（54.31±7.29）°、（68.84±6.37）°］，两者比较差异有统计学意义（t=26.35，P＜0.05）。观察组与对照组在静息状态下，d-LHVC分别为［（8.74±2.21）mm、（5.45±1.87）mm］，两者比较差异有统计学意义（t=16.24，P＜0.05）；观察组与对照组在力排状态下，盆底裂孔纵轴偏离中心位置的距离（d-LHVC）分别为［（12.31±2.32）mm、（6.47±2.16）mm］，两者比较差异有统计学意义（t=-11.36，P＜0.05）。

结论

难治性排便障碍型便秘患者在静息状态下即存在盆底裂孔中轴偏移，力排状态下盆底裂孔横径、后角较正常人变小，且盆底裂孔中轴发生偏移幅度较正常人明显增大，盆底裂孔形态存在明显不对称改变。

关键词: 便秘, 磁共振, 排便障碍, 盆底裂孔
Objective

To investigate the changes of pelvic floor hiatus in patients with refractory dysdefecation constipation under magnetic resonance imaging (MRI).

Methods

Sixty patients with refractory dysdefecation constipation (observation group) and 37 healthy volunteers (control group) were selected prospectively in the First Affiliated Hospital of Shandong First Medical University. The transverse diameter (LH-W), longitudinal diameter (LH-L), posterior angle of pelvic floor hiatus (LH-PA), and the distance of longitudinal axis of pelvic floor hiatus from the center (d-LHVC) were compared between the two groups.

Results

The transverse diameter (LH-W) and longitudinal diameter (LH-L) of the pelvic floor hiatus in the observation group and the control group were respectively [(2.64±1.89) cm, (2.59±2.44) cm; (7.35±2.52) cm, (6.82±2.07) cm], and there was no significant difference between the two groups (t=0.763, 0.39; P＞0.05). The transverse diameter (LH-W) and longitudinal diameter (LH-L) of the pelvic floor hiatus in the observation group and the control group were respectively [(3.37±2.26) cm, (4.11±3.84) cm; (6.64±2.29) cm, (5.54±1.84) cm], and the differences were statistically significant (t=-6.11, 9.71; P＜0.05). The posterior angle of pelvic floor hiatus (LH-PA) in the observation group and the control group were (48.57±5.23)°, (45.12±6.28)°, respectively, and there was no significant difference between the two groups (t=2.58, P＞0.05). The posterior angle of pelvic floor hiatus (LH-PA) in the observation group and the control group were (54.31±7.29)°, (68.84±6.37)°, respectively, with statistical difference (t=26.35, P＜0.05). In the resting state, the distance (d-LHVC) of the longitudinal axis of the pelvic floor hiatus was (8.74±2.21) mm and (5.45±1.87) mm respectively in the observation group and the control group, and the difference was statistically significant (t=16.24, P＜0.05), The distance (d-LHVC) of the longitudinal axis of the pelvic floor hiatus was (12.31±2.32) mm and (6.47±2.16) mm respectively in the observation group and the control group, and the difference was statistically significant (t=-11.36, P＜0.05).

Conclusion

The patients with refractory dysdefecation constipation have the central axis deviation of pelvic floor hiatus in resting state. The transverse diameter and posterior angle of pelvic floor hiatus are smaller than those of normal people under forced defecation state, and the deviation amplitude of pelvic floor hiatus axis is significantly larger than that of normal people, and the shape of pelvic floor hiatus is significantly asymmetric.

Key words: Constipation, Magnetic resonance, Dysporia, Pelvic floor hole
图1 水平轴位盆底裂孔MR结构图。蓝、黄、白色箭头所示分别为盆底裂孔横径（LH-W）、盆底裂孔纵径（LH-L）、盆底裂孔后角（LH-PA）
图2 水平轴位盆底裂孔MR结构图。黄色、绿色、灰色箭头所示分别为盆底裂孔纵轴（LH-V）、盆底裂孔中心位置（LH-C）、盆底裂孔纵轴偏离中心位置的距离（d-LHVC）
表1 观察组与对照组盆底裂孔横径和纵径比较（
xˉ
±s）
组别 例数 LH-W（cm） LH-L（cm）
静息 力排 静息 力排
观察组 60 2.64±1.89 3.37±2.26 7.35±2.52 6.64±2.29
对照组 37 2.59±2.44 4.11±3.84 6.82±2.07 5.54±1.84
t值 0.763 -6.11 0.39 9.71
P值 0.452 0.00 0.70 0.00
表2 观察组和对照组盆底裂孔纵轴偏离中心位置的距离与盆底裂孔后角比较（
xˉ
±s）
组别 d-LHVC（mm） LH-PA（°）
静息 力排 静息 力排
观察组 8.74±2.21 12.31±2.32 48.57±5.23 54.31±7.29
对照组 5.45±1.87 6.47±2.16 45.12±6.28 68.84±6.37
t值 16.24 -11.36 2.58 26.35
P值 0.04 0.00 0.71 0.00
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