经会阴及经肛门三维超声技术对功能性肛门直肠疾病的评估  

Evaluation of functional anorectal disorder by transperineal and three-dimensional endoanal ultrasound

作　　者：薛雅红[1] 刘飞[1] 凌艳[1] 王小峰[1] Yahong Xue;Fei Liu;Yan Ling;Xiaofeng Wang(Anorectal Department,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210022,China)

机构地区：[1]南京中医药大学附属南京中医院肛肠科,210022

出　　处：《中华消化病与影像杂志（电子版）》2022年第6期334-341,共8页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：南京市卫生局重点项目(ZKX19035)

摘　　要：目的评估经会阴超声(TPUS)及三维肛管直肠腔内超声(3D-EAUS)技术对功能性肛门直肠疾病的临床诊断价值。方法回顾性分析2019年1月至2021年3月南京市中医院肛肠科收治的功能性肛门直肠疾病患者138例,其中功能性排便障碍96例,大便失禁14例,功能性肛门直肠痛28例。TPUS测量膀胱颈移动度(BND)、膀胱尿道后角(RVA)、肛直角、直肠前突等指标;3D-EAUS评估肛门括约肌完整性、测量耻骨直肠肌角。结果TPUS:80例女性功能性排便障碍患者中,最大Valsalva时10例(12.5%)BND>25 mm,23例(28.75%)RVA>140°,发现直肠前突45例(56.25%),直肠黏膜内套叠43例(53.75%),肠疝1例(1.25%);22例女性功能性肛门直肠痛患者中,最大Valsalva时2例(9.1%)BND>25 mm,4例(18.2%)RVA>140°,发现直肠前突11例(50%),直肠黏膜内套叠13例(59.1%);女性功能性排便障碍及功能性肛门直肠痛患者肛直角在静息状态和最大Valsalva时比较,差异均无统计学意义(P>0.05)。3D-EAUS:16例男性功能性排便障碍患者静息及最大Valsalva时耻骨直肠肌角差异有统计学意义[(88.84±3.80)°比(87.54±3.47)°,P<0.05]。14例大便失禁患者中,5例括约肌重度缺损(评分:10~13分),累及内外括约肌,均是产伤引起的会阴撕裂;1例中度缺损(评分:6分);3例轻度缺损(评分:3~4分)。功能性排便障碍女性患者中有41例最大Valsalva时的肛直角和耻骨直肠肌角均明显小于静息状态,差异比较有显著统计学意义(P<0.01)。结论TPUS及3D-EAUS技术能准确评估功能性肛门直肠疾病患者盆底形态学特征,并能发现其他伴随的盆底功能障碍,评估具有整体性。Objective To evaluate the diagnostic value of transperineal ultrasound(TPUS)and three-dimensional endoanal ultrasound(3D-EAUS)for functional anorectal disorder(FAD).MethodsA total of 138 patients with FAD admitted to the Anorectal Department of Nanjing Hospital of Traditional Chinese Medicine from January 2019 to March 2021 were retrospectively analyzed,including 96 cases of functional defecation disorder(FDD),14 cases of fecal incontinence(FI)and 28 cases of functional anorectal pain(FARP).Bladder neck descent(BND),retrovesical angle(RVA),anorectal angle(ARA),rectocele(RC)were measured by TPUS.Assessment of sphincter integrity and measurement of puborectalis angle were taken using 3D-EAUS.ResultsTPUS:In 80 female patients with FDD,10(12.5%)patients had BND>25 mm at the maximum Valsalva,23(28.75%)patients had RVA>140°,45(56.25%)patients had RC,43(53.75%)patients had rectal intussusception(RI)and 1(1.25%)patient had enterocele.Among 22 female patients with FARP,2(9.1%)patients had BND>25 mm at the maximum Valsalva,4(18.2%)patients had RVA>140°,11(50%)patients had RC and 13(59.1%)patients had RI.No significant differences were observed in ARA between the resting state and the maximum Valsalva in female patients with FDD and FARP(P>0.05).3D-EAUS:There was a significant difference in the puborectalis angle between the resting state and the maximum Valsalva in 16 male patients with FDD[(88.84±3.80)°vs.(87.54±3.47)°,P<0.05].In 14 cases of FI,5 cases had severe sphincter defect(score:10 to13 points),involving the internal and external sphincter,all of which were perineal laceration caused by birth injury,1 case of moderate defect(score:6 points),and 3 cases of mild defect(score:3 to 4 points).In 41 female patients with FDD,both the ARA and puborectalis angle at the maximum Valsalva were significantly smaller than those at the resting state(P<0.01).ConclusionThe TPUS and 3D-EAUS can accurately assess the morphological features of the pelvic floor in FAD patients,and detect other accompanying pelvic floor disorders.

关 键 词：肛门直肠疾病 功能性排便障碍 大便失禁 功能性肛门直肠痛 经会阴超声 三维肛管直肠腔内超声 

分 类 号：R657.1[医药卫生—外科学]