子宫托置入对盆腔解剖结构的影响：基于直立位磁共振的前瞻性观察研究
本研究为前瞻性观察性队列研究，纳入15名使用环形子宫托成功的盆腔器官脱垂（POP）患者。通过直立位磁共振成像，测量子宫托置入前、置入后即刻及1周后膀胱、宫颈最低点及子宫和子宫托的角度变化。结果显示，置入子宫托后膀胱最低点短暂上提但1周后回落，而宫颈位置上提和子宫角度变化在1周后仍维持。提示子宫托对子宫的支撑作用可能与其缓解POP症状的机制相关。
要点
- 子宫托置入后宫颈位置上提且1周后仍维持，而膀胱上提效果1周后减弱。
- 子宫与盆腔倾斜校正系统（PICS）线夹角在置入后增大并维持，提示子宫角度改变。
- 子宫托自身位置在1周内出现轻微下移，但角度无明显变化。
核心结论
- 子宫托置入改变了盆腔器官的位置和角度。
- 初始上提效果中，对膀胱的作用在1周后减弱，而对子宫的作用得以维持。
- 子宫的上提作用可能在缓解POP症状中发挥作用。
研究设计与样本
- 前瞻性观察性队列研究。
- 研究地点为妇科门诊。
- 纳入15名成功使用环形子宫托的POP患者。
主要发现
- 子宫托置入将膀胱最低点从PICS线下方0.1 cm提升至上方0.6 cm（p = 0.015）。
- 1周后膀胱最低点回落至PICS线上方0.2 cm（p = 0.334）。
- 宫颈最低点从PICS线0.0 cm提升至上方2.5 cm（p < 0.001），并在1周后维持。
关键数值与推荐
- 膀胱最低点：置入即刻为PICS线上方0.6 cm，1周后为上方0.2 cm。
- 宫颈最低点：置入后为PICS线上方2.5 cm，1周后无显著变化（p = 0.470）。
- 子宫角度：置入后从97°增至115°（p = 0.008），1周后为113°（p = 0.198）。
- 子宫托位置：1周内从PICS线下方0.7 cm变为下方0.3 cm（p = 0.020）；角度无显著变化（56°至54°，p = 0.820）。
临床怎么用
- 子宫托置入可提高宫颈位置并维持，可能有助于改善POP症状。
- 置入后早期膀胱位置提升，但效果不持久，临床评估时需注意。
- 子宫托位置在1周内可轻微下移，建议随访时复查子宫托位置。
局限性
- 研究样本量为15例，相对较小。
- 仅纳入环形子宫托使用者，可能不代表其他类型子宫托。
- 研究观察期为1周，长期效果未知。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To determine the anatomical effect of pessaries in the upright position in women with pelvic organ prolapse (POP). Design Prospective observational cohort study. Setting Outpatient clinic of our gynaecology department. Population Fifteen POP patients with successful ring-shaped pessary use. Methods Upright magnetic resonance (MR) images of the pelvis were acquired before, immediately after insertion of their pessaries, and 1 week later. Main Outcome Measures Distances from the lowest points of the bladder, cervix, and pessary to the pelvic inclination correction system (PICS) line were measured, as well as the angles of the uterus and pessary relative to the PICS in the midsagittal plane. Results Pessary insertion lifted the bladder's lowest point from 0.1 cm below to 0.6 cm above the PICS (p = 0.015), but it descended to 0.2 cm above the PICS 1 week later (p = 0.334). The cervix was lifted from 0.0 to 2.5 cm above the PICS (p < 0.001), which persisted after 1 week (p = 0.470). The angle between uterus and PICS increased after insertion from 97o to 115o (p = 0.008) and remained stable (113°, p = 0.198). Pessary position changed from 0.7 to 0.3 cm below the PICS in 1 week (p = 0.020); the angle did not change (56° to 54°, p = 0.820). Conclusion Pessary insertion changes the pelvic organ position and angulation. After an initial lift, the effect on the bladder diminished after 1 week, while for the uterus it remained. This may suggest a role for uterus lift in relieving POP symptoms.
引用
- BJOG：The Effect of Pessary Insertion on Pelvic Anatomy: A Prospective Observational Study Using Upright MRI
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。