Liang S Q, Chen C L, Liu P, Tang L, Huang L, Jiang W X, Li Y W
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Jan 25;56(1):27-33. doi: 10.3760/cma.j.cn112141-20200612-00500.
To study the anatomical relationship among uterosacral ligament and ureter or rectum by using MRI three-dimensional reconstruction model in pelvic organ prolapse (POP) patients. According to the research standard, 67 POP patients were enrolled, who accepted pelvic MRI before surgery in Nanfang Hospital, Southern Medical University during May 2015 to March 2020. Three-dimensional model of uterosacral ligament was reconstructed. The intersection point of the fitting curve of uterosacral ligament and ischial spine level marked point P0, every 1 cm increasing from P0 towards the sacrum marked points P1, P2, and P3. Distances were measured between rectum or ureter to uterosacral ligament respectively at the P0-P3 horizontal levels. (1) The distances between the left ureter and the left uterosacral ligament were (15.45±7.46) to (19.31±11.38) mm, and the distances between the right ureter and the right uterosacral ligament were (13.77±8.16) to (14.78±9.18) mm. At the P1 horizontal level ureters were the closest to uterosacral ligaments, and the right ureter was the closest to right uterosacral ligament [(13.45±9.34) mm] at P2 horizontal level in severe POP group. The farthest distance presented at the P3 horizontal level between bilateral ureters and uterosacral ligaments. (2) At the P0 horizontal level, the rectum was the closest to the bilateral uterosacral ligaments [left: (20.62±9.99) mm, right: (16.82±9.63) mm; =0.026], and the rectum was closer to the right uterosacral ligament. There were no significant differences in the distance between rectum and bilateral uterosacral ligaments in mild POP group (>0.05), and the results of severe POP group also showed the rectum was closer to the right uterosacral ligament [(15.64±10.31) mm at P0 horizontal level]. Right ureter and rectum are closer to the right uterosacral ligament. Gynecologists should pay more attention to avoid damaging the right ureter and rectum during the operation of the right uterosacral ligament in POP patients.
利用盆腔器官脱垂（POP）患者的MRI三维重建模型研究子宫骶韧带与输尿管或直肠之间的解剖关系。根据研究标准，纳入67例POP患者，这些患者于2015年5月至2020年3月在南方医科大学南方医院手术前接受了盆腔MRI检查。重建子宫骶韧带的三维模型。子宫骶韧带拟合曲线与坐骨棘水平标记点P0的交点，从P0向骶骨每增加1 cm标记点P1、P2和P3。分别在P0 - P3水平测量直肠或输尿管至子宫骶韧带的距离。（1）左输尿管与左子宫骶韧带的距离为（15.45±7.46）至（19.31±11.38）mm，右输尿管与右子宫骶韧带的距离为（13.77±8.16）至（14.78±9.18）mm。在P1水平输尿管最靠近子宫骶韧带，在重度POP组中，在P2水平右输尿管最靠近右子宫骶韧带[（13.45±9.34）mm]。双侧输尿管与子宫骶韧带之间的最远距离出现在P3水平。（2）在P0水平，直肠最靠近双侧子宫骶韧带[左侧：（20.62±9.99）mm，右侧：（16.82±9.63）mm；P = 0.026]，且直肠更靠近右子宫骶韧带。轻度POP组直肠与双侧子宫骶韧带之间的距离无显著差异（P>0.05），重度POP组结果也显示直肠更靠近右子宫骶韧带[P0水平为（15.64±10.31）mm]。右输尿管和直肠更靠近右子宫骶韧带。妇科医生在POP患者右子宫骶韧带手术过程中应更加注意避免损伤右输尿管和直肠。
