检索历史 清除

目的 评估三维腔内超声(3D?EAUS)对盆底失弛缓综合征的诊断价值.方法 采用病例对照研究方法,回顾性收集2012年2月至2015年4月期间,南京市中manbet官网登录 肛肠科收治的盆底失弛缓患者46例(盆底失弛缓组),所有患者均符合功能性便秘罗马Ⅲ诊断标准,并经肛门直肠压力测定检查,证实存在力排时耻骨直肠肌的反常收缩;全组男性16例,女性30例;年龄20~77(中位数51)岁.纳入同期无盆底手术史、近6个月内排粪正常的健康志愿者45例(健康对照组),其中男性22例,女性23例;年龄21~72(中位数48)岁.两组性别和年龄的差异无统计学意义(均P>0.05).盆底失弛缓组的克利夫兰便秘评分高于健康对照组[中位数15(8~24)分比中位数5(1~9)分],差异有统计学意义(t=15.720,P<0.001).两组均接受3D?EAUS检查,分别测量肛门内括约肌厚度、内括约肌长度(前侧和后侧)、耻骨直肠肌厚度、外括约肌至耻骨直肠肌长度及耻骨直肠肌角等超声检测指标.组间比较采用t检验;并采用Pearson相关性分析法,分析盆底失弛缓组超声检测指标与肛门直肠压力结果的相关性.结果 不同性别的盆底失弛缓组患者肛门内括约肌厚度均大于健康对照组,差异有统计学意义[男性:(1.7±0.5)mm比(1.5±0.2)mm,t=2.516,P=0.016;女性:(1.9±0.4)mm比(1.6±0.5)mm,t=2.034,P=0.047].两组间后侧内括约肌长度、外括约肌至耻骨直肠肌长度、耻骨直肠肌厚度的差异均无统计学意义(均P>0.05).盆底失弛缓组男性与健康对照组比较,力排时耻骨直肠肌角更小,差异有统计学意义[(87.0±3.6)°比(90.5±1.8)°,t=3.502,P=0.002];盆底失弛缓组女性静息和力排时耻骨直肠肌角均较健康对照组变小,差异均有统计学意义[静息:(86.5±3.8)°比(90.1±2.1)°,t=4.047,P<0.001;力排:(84.1±4.5)°比(90.2±2.3)°,t=5.938,P<0.001].与肛门直肠测压的相关性分析结果显示,盆底失弛缓组患者前侧内括约肌长度与肛管静息压呈正相关(r=0.321,P=0.030);外括约肌至耻骨直肠肌长度与肛管收缩压呈正相关(r=0.415,P=0.004);但内括约肌厚度、后侧内括约肌长度与肛管静息压,以及耻骨直肠肌厚度与肛管收缩压无相关性(均P>0.05).结论 3D?EAUS检查可准确评估盆底失弛缓患者肛管形态学特征,其与肛门直肠测压结果有一定正相关性.

Objective To evaluate the diagnostic value of three?dimensional endoanal ultrasound (3D ? EAUS) for dyssynergic defecation (DD). Methods A case ? control study was performed to retrospectively collectclinical data of 46 DD patients, including 16 males and 30 females with median age of 51 (20 to 70) years, at Nanjing Hospital of Chinese Medicine from February 2012 to April 2015. All the patients met the diagnostic criteria of functional constipation of Rome III. The paradoxical contraction of puborectalis (PR) muscle was found by both rectal examination and anorectal manometry. In the same period, 45 healthy volunteers, including 22 males and 23 females with median age of 48 (21 to 72) years, without pelvic operation history, and with normal defecation in recent 6 months, were enrolled as the control group. No significant differences were observed in age and gender between two groups (both P>0.05). Cleveland constipation score of DD group was higher than that of control group [15(8?24) vs. 5(1?9), t=15.720, P<0.001]. 3D?EAUS examination was performed in all the subjects. Thickness and length of internal anal sphincter (IAS) (anterior side and posterior side), thickness of PR muscle, length of external anal sphincter (EAS) plus PR muscle, and puborectalis angle were measured and compared by using student t test between two groups. Correlation between these ultrasound parameters and anorectal manometry was examined by Pearson correlation analysis. Results Both male and female in the DD group had the greater thickness of IAS, as compared to those in the control group [male: (1.7±0.5) mm vs.(1.5±0.2) mm, t=2.516, P=0.016; female: (1.9± 0.4) mm vs. (1.6 ± 0.5) mm, t=2.034, P=0.047]. No significant differences between the two groups were observed with respect to the posterior length of IAS, length of EAS plus PR muscle, and thickness of PR muscle (all P>0.05). Compared to the control group, male in the DD group had smaller puborectalis angle during straining [(87.0 ± 3.6)° vs. (90.5 ± 1.8)°, t=3.502, P=0.002]; female in the DD group had smaller puborectalis angle both in resting and straining [resting: (86.5 ± 3.8)° vs. (90.1 ± 2.1)°, t=4.047, P<0.001;straining: (84.1±4.5)°vs. (90.2±2.3)°, t=5.938, P<0.001]. Correlation analysis showed that anterior length of IAS was positively correlated with anal resting pressure (r=0.321, P=0.030); the length of EAS plus PR muscle was positively correlated with anal squeeze pressure (r=0.415, P=0.004). There were no correlations between the thickness and the posterior length of IAS and the anal resting pressure, or between the thickness of PR muscle and the anal squeeze pressure (all P>0.05). Conclusions The 3D?EAUS can accurately assess the morphological features of anal canal in DD patients. There is a certain positive correlation between 3D?EAUS and anorectal manometry.