van den Noort Frieda, de Alba Alvarez I, van der Steen A, Smelt A D, Simonis F F J, Grob A T M
Multi-Modality Medical Imaging (M3I), TechMed Centre, University of Twente, Technohal 2384,Drienerolaan 5, Enschede, 7522NB, The Netherlands.
Department of Gynecology, Ziekenhuisgroep Twente, Hengelo/Almelo, The Netherlands.
Sci Rep. 2024 Dec 28;14(1):30951. doi: 10.1038/s41598-024-81985-9.
Vaginal pessaries have been used for millennia to alleviate symptoms of pelvic organ prolapse (POP). Despite their long-standing use, the success rate of pessary treatment is approximately 60%, and the underlying mechanisms of support are not well understood. This study aims to investigate three previously proposed hypotheses regarding the support mechanisms of pessaries, utilizing supine and upright magnetic resonance imaging (MRI): (1) support by bony structures, (2) support by levator ani muscles (LAM), and (3) the uterus keeping the pessary in place by acting as a lever. Thirty POP patients, with a successful pessary fit for more than 3 months, underwent MRI scans in both upright and supine position. The position of the pelvic bony structures, LAM, uterus, and pessary were analysed by placing corresponding points on these structures and comparing the differences between supine and upright. Also, the angle of the pessary with the horizontal plane of the pelvic inclination corrections system was analysed. Principal component analysis was applied to evaluate how the positions of the LAM and the pessary changed between the two positions. The lowest point of the pessary descends below the lowest point of the bony structures in upright position, disproving the first hypothesis. The pessary significantly descends towards the LAM from supine to upright, but does not drop below it, strengthening the second hypothesis. The pessary angle is below 90° in upright position, the uterus is positioned in the pessary centre and remains constant from supine to upright, strengthening the third hypothesis.
阴道子宫托已被使用了数千年，用于缓解盆腔器官脱垂（POP）的症状。尽管其使用历史悠久，但子宫托治疗的成功率约为60%，其支撑的潜在机制尚不清楚。本研究旨在利用仰卧位和直立位磁共振成像（MRI），研究先前提出的关于子宫托支撑机制的三个假设：（1）由骨性结构支撑；（2）由肛提肌（LAM）支撑；（3）子宫通过作为杠杆作用使子宫托保持在位。30例子宫托适配成功超过3个月的POP患者，分别在直立位和仰卧位接受了MRI扫描。通过在这些结构上放置相应的点并比较仰卧位和直立位之间的差异，分析盆腔骨性结构、LAM、子宫和子宫托的位置。此外，还分析了子宫托与盆腔倾斜校正系统水平面的角度。应用主成分分析来评估LAM和子宫托在两个位置之间的位置变化。子宫托的最低点在直立位低于骨性结构的最低点，这否定了第一个假设。从仰卧位到直立位，子宫托明显向LAM下降，但未降至其下方，这支持了第二个假设。在直立位，子宫托角度低于90°，子宫位于子宫托中心，从仰卧位到直立位保持不变，这支持了第三个假设。
