Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Eur J Radiol. 2011 Nov;80(2):182-7. doi: 10.1016/j.ejrad.2010.03.014. Epub 2010 Apr 10.
The purpose of the study was to assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh.
Fifteen consecutive patients (mean age 66.5 years) who were scheduled for either anterior (n=9) or posterior (n=6) pelvic floor repair were prospectively evaluated by clinical assessment and dynamic MRI 1 day before and 3 months after surgery. MRI diagnoses and MRI measurements of relevant anatomical points at rest and on straining were analysed before and after surgery.
At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed (n=6) or increased (n=6) pelvic organ prolapse in 80% (n=12) of all patients 3 months after pelvic floor repair. Most of them (n=11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly (p<0.05) elevated after anterior repair and rectal bulging was significantly (p=0.036) reduced after posterior pelvic floor repair.
In this study dynamic MRI could verify the effective support of anterior and posterior pelvic floor structures by anterior and posterior polypropylene implant respectively. But dynamic MRI demonstrates if one compartment of the pelvic floor is repaired another compartment frequently (73.3%) develops dysfunction. These results did not correspond to clinical symptoms on short-term follow-up (3 months). Studies with long-term follow-up are necessary to prove if dynamic MRI can reliably identify clinically significant pelvic organ prolapse after pelvic floor repair before the onset of symptoms.
本研究的目的是评估在接受聚丙烯网片盆底修复后，对盆腔器官脱垂患者进行动态 MRI 的作用。
连续纳入 15 例（平均年龄 66.5 岁）拟行前盆腔（n=9）或后盆腔（n=6）盆底修复术的患者，分别在术前 1 天和术后 3 个月行临床评估和动态 MRI 检查。对术前和术后 MRI 诊断及相关解剖学指标的静息和收缩状态下的 MRI 测量值进行分析。
在随访评估时，所有患者中有 93.3%临床治愈。动态 MRI 显示在盆腔器官脱垂修复术后 3 个月，80%（n=12）的所有患者中有新发生（n=6）或加重（n=6）的盆腔器官脱垂。其中大部分（n=11；91.7%）累及未治疗的盆底间隙。在收缩状态下，前盆腔间隙的解剖学参考点在前盆底修复后明显升高（p<0.05），而直肠膨出在后盆底修复后明显减少（p=0.036）。
在这项研究中，动态 MRI 可以证实前盆腔和后盆腔结构分别由前盆腔和后盆腔聚丙烯植入物有效支撑。但动态 MRI 显示，如果一个盆底间隙得到修复，另一个间隙通常（73.3%）会出现功能障碍。这些结果与短期（3 个月）随访的临床症状不符。需要进行长期随访的研究，以证明在出现症状之前，动态 MRI 是否可以可靠地识别盆腔器官脱垂患者接受盆底修复术后的临床显著盆腔器官脱垂。
