Objective: To explore the effects of menopausal factor on fine anatomy of bladder, urethra and vagina in women undergoing vaginal delivery. Methods: Gynecological patients in Nanfang hospital from January 2013 to October 2016 were collected, and then the patients whose MRI images quality meet the require of reconstruction, with the history of vaginal delivery experience, without any cesarean section experience, and the first labor time was ≤30 years old were enrolled. The patients who had pelvic floor dysfunction when done MRI examinations were excluded. Finally, 238 cases were randomly selected out, and 238 models of data were reconstructed and measured by Mimics and UG software. The independent t test was used to do the comparison between menopausal group and those not yet menopause. Results: First, we built 238 3D models totally. Second, the parameters related with bladder and urethra: the angle of bladder and urethra, β angle, urethra pubic angle, α angle, retropubic space, the length between bladder neck and edge of pubic midpoint, and urethral striated muscle thickness of menopausal group were bigger than those of pre-menopausal group. While for the urethra tilt angle, the former group was smaller than that of the latter group. But there was no significant statistical differences between two groups. Third, the parameters related with vagina: the proximal urethral vaginal gap of the post-menopause group was smaller than that of pre-menopausal group, while for the middle and distal urethral vaginal gap, the former group was bigger than that of the latter group. The length and width of vaginal anterior wall of the post-menopausal group were smaller than those of pre-menopausal group. Beside the middle urethral vaginal gap, all the difference between two groups had no statistical meaning. The 2D shape of axial vaginal, H type occupation of the former group was obviously lower than that of the latter group. Conclusions: Menopause has an effect on fine anatomy of pelvic organ. Especially on the shape of vagina, the middle urethral vaginal gap become much wider after menopause, the occupation of shallow concave type become much higher post-menopausal. It means the lateral and backward support function of the urethra and vagina is relatively weakened after menopausal, and the shape of vagina become smaller.
目的： 探讨绝经因素对已育女性膀胱尿道及阴道精细解剖结构的影响。 方法： 对2013年1月至2016年10月于南方医科大学南方医院就诊的妇科患者，选择满足重建要求的MRI数据、有阴道分娩史、无剖宫产史、初胎分娩年龄≤30岁，排除有盆底功能障碍相关症状的患者。共纳入238例患者。利用Mimics和UG软件对所有MRI数据进行建模与测量，已绝经组与未绝经组的比较采用独立样本t检验。 结果： (1)共构建238例盆底器官三维模型。(2)与膀胱尿道相关指标：膀胱尿道后角、β角、尿道耻骨角、α角、尿道横纹肌厚度、耻骨后间隙以及膀胱颈距离耻骨联合下缘中点连线长度(BN－PB连线长度)，已绝经组比未绝经组要大；尿道倾斜角，已绝经组则要比未绝经组小，但差异均无统计学意义。(3)与阴道解剖相关指标：近端尿道阴道间隙已绝经组要比未绝经组小，而中段和远端尿道阴道间隙已绝经组要比未绝经组增宽，近端和远端阴道前壁宽度和阴道前壁中线长度已绝经组要比未绝经组小，除外中段尿道阴道间隙，其余参数两组间差异均无统计学意义。已绝经组中段阴道H型占比明显低于未绝经组，浅凹型占比则明显高于未绝经组。 结论： 绝经会改变女性盆底器官的部分解剖参数，尤其是阴道形态改变明显，中远段尿道阴道间隙明显增宽，阴道浅凹型占比明显增加，反映绝经后，尿道和阴道后壁及旁侧支持功能下降，阴道开始出现萎缩表现。.
Keywords: Anatomy; Menopausal; Pelvic organ; Three-dimensional; Vaginal delivery.