Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.
Am J Obstet Gynecol. 2010 May;202(5):497.e1-6. doi: 10.1016/j.ajog.2010.01.001.
The objective of the study was to compare pelvic structure location on magnetic resonance imaging (MRI) during maximal Valsalva among women with posterior prolapse and those with normal support.
Subjects (n=37) had posterior vaginal wall (PVW) prolapse of +1 cm or greater. All underwent midsagittal, dynamic MRI. Structure locations (distal vagina, apex, perineal body, external anal sphincter) were determined. PVW length, levator and urogenital hiatus diameters, and prolapse diameter were measured.
Subjects had more caudal structures (P<.001) and larger hiatus diameters (P<.005); the posterior wall was longer, whereas the straight-line distance between the apex and distal vagina was shorter. In enteroceles, the apex was more ventrally displaced compared with rectoceles (P=.003). Unlike apical descent (r=-0.3; P=.1), PVW length and point Bp were correlated with MRI prolapse size (r=0.5; P=.002; r=0.7; P<.001, respectively).
At maximal Valsalva on MRI, structures are more caudal in women with posterior prolapse. The posterior vaginal wall is longer; this length strongly correlates with prolapse size.
本研究旨在比较磁共振成像（MRI）中在最大 Valsalva 时，有和无后部脱垂的女性的骨盆结构位置。
受试者（n=37）有阴道后壁（PVW）脱垂+1cm 或更大。所有受试者均接受正中矢状位、动态 MRI。确定结构位置（远端阴道、顶点、会阴体、肛门外括约肌）。测量 PVW 长度、肛提肌和泌尿生殖膈直径以及脱垂直径。
与无脱垂者相比，受试者的结构更靠后（P<.001），且 hiatus 直径更大（P<.005）；后壁更长，而顶点和远端阴道之间的直线距离更短。在肠膨出中，与直肠膨出相比，顶点更向腹侧移位（P=.003）。与顶点下降（r=-0.3；P=.1）不同，PVW 长度和 Bp 点与 MRI 脱垂大小相关（r=0.5；P=.002；r=0.7；P<.001）。
在 MRI 最大 Valsalva 时，有后部脱垂的女性的结构更靠后。阴道后壁更长；此长度与脱垂大小有很强的相关性。
