A new 3D stress MRI measurement strategy to quantify surgical correction of prolapse in three support systems.
A new 3D stress MRI measurement strategy to quantify surgical correction of prolapse in three support systems.
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DOI：
10.1002/nau.24781
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发表时间：
2021-11
影响因子：
2
通讯作者：
DeLancey JO
中科院分区：
文献类型：
--
作者：
Chen L;Swenson CW;Xie B;Ashton-Miller JA;DeLancey JO
本研究的目的是开发和测试基于MRI的测量策略的可行性，以评估手术在恢复所有三个盆底支撑系统的正常解剖结构方面的有效性，并量化脱垂手术引起的结构变化。患者在术前和术后3个月再次接受临床检查和负荷MRI。对三种基于MRI的结构支撑系统进行了术前和术后测量：1）阴道壁，2）顶端和阴道旁支撑，3）食管裂孔闭合系统。计算术前到术后的结构变化，并与正常值进行比较，确定双变量相关性。在试验组的所有15名女性中，无论手术入路如何，术前和术后MRI均成功量化了三种结构支持系统。12名接受顶端悬吊术的患者中，有11名的顶端支撑恢复正常，14名接受后部修复的患者中，有9名的生殖器裂孔尺寸恢复正常。尽管未进行阴道旁修补术，但阴道中段阴道旁位置平均升高2.5 ± 2.0 cm。阴道旁位置的改善也与根尖抬高显著相关（r值0.99 - 0.87，p <0.001）。成功地制定了一项量化脱垂手术后结构特异性术前损伤和改善的策略。早期研究结果表明，脱垂手术在恢复I级正常解剖结构方面比III级更成功。阴道旁位置的改善与根尖抬高显著相关。
The aim of this study was to develop and test the feasibility of an MRI-based measurement strategy to evaluate the effectiveness of surgical procedures in restoring normal anatomy in all three systems of pelvic floor support and quantify the structural changes induced by prolapse surgery. Patients underwent clinical examination and stress MRI preoperatively and again three months postoperatively. Pre- and postoperative measures of three MRI-based structural support systems were made: 1) vaginal wall, 2) apical and paravaginal support, and 3) hiatal closure system. Pre- to postoperative structural changes were calculated and compared to normal values, and bivariate associations were determined. The three structural support systems were successfully quantified for both preoperative and postoperative MRIs regardless of operative approaches in all 15 women in the pilot group. Apical support was restored to normal in 11 of 12 patients who underwent an apical suspension procedure and nine of 14 patients with a posterior repair had normalization of genital hiatus size. Mid-vaginal paravaginal location was elevated an average of 2.5 ± 2.0 cm despite no paravaginal repairs being performed. Paravaginal location improvements were also significantly correlated with apical elevation (r values 0.99–0.87, p<0.001). A strategy that quantifies structural-specific preoperative impairments and improvements after prolapse surgery was successfully developed. Early findings reveal that prolapse surgery is more successful in restoring normal anatomy at Level I than Level III. Improvement in paravaginal location is significantly correlated with apical elevation.
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影响因子：
1.8
作者：
Larson, Kindra A.;Luo, Jiajia;Guire, Kenneth E.;Chen, Luyun;Ashton-Miller, James A.;DeLancey, John O. L.
通讯作者：
DeLancey, John O. L.
影响因子：
7.2
作者：
Wu JM;Vaughan CP;Goode PS;Redden DT;Burgio KL;Richter HE;Markland AD
通讯作者：
Markland AD
影响因子：
7.2
作者：
Vergeldt, Tineke F. M.;van Kuijk, Sander M. J.;Weemhoff, Mirjam
通讯作者：
Weemhoff, Mirjam
影响因子：
7.2
作者：
Larson, Kindra A.;Smith, Tovia;Morgan, Daniel M.
通讯作者：
Morgan, Daniel M.
影响因子：
1.8
作者：
Fairchild, Pamela S.;Kamdar, Neil S.;Morgan, Daniel M.
通讯作者：
Morgan, Daniel M.