不同体位下动态MRI排粪造影对出口梗阻型便秘病因诊断的影响(附16例报告)  

To evaluate dynamic magnetic resonance imaging defecography in etiological diagnosis of outlet obstruction constipation with changes in position

作　　者：王永兵[1] 丁俞江 谢禹昌[2] 

机构地区：[1]上海市浦东新区人民医院肛肠外科,上海201200 [2]上海市浦东新区人民医院放射科,上海201200

出　　处：《结直肠肛门外科》2013年第4期203-206,共4页Journal of Colorectal & Anal Surgery

基　　金：上海市浦东新区卫生局重点学科建设基金(PWZxk2010-01)

摘　　要：目的探讨不同体位下动态MRI排粪造影对出口梗阻型便秘(OOC)病因诊断的影响。方法对16例有不同程度排便困难,并已接受X线排粪造影检查证实为OOC的患者进行动态MRI排粪造影检查。动态图像采集采用正中矢状位FIESTA序列连续扫描,于第1 d、第3 d分别取仰卧位、仰卧位+膝髋屈曲,比较分析两种体位下MRI排粪造影诊断的结果。结果仰卧位MRI排粪造影,16例患者中,直肠前膨出6例、直肠脱垂与内套叠5例、耻骨直肠肌综合征1例、盆底疝3例、子宫后倾2例、膀胱膨出3例、子宫脱垂1例、会阴下降综合征4例;仰卧位+膝髋屈曲位MRI排粪造影,检测出直肠前膨出7例、直肠脱垂与内套叠9例、耻骨直肠肌综合征1例、盆底疝4例、子宫后倾2例、膀胱膨出3例、直肠下降1例、会阴下降综合征7例。比较两种体位下动态MRI排粪造影OOC病因诊断的结果,仰卧+膝髋屈位检查在直肠脱垂或套叠、会阴下降的诊断方面较单纯仰卧位具有一定的优势(P<0.05)。结论动态MRI排粪造影能提供盆底组织器官的动静态形态影像,显示盆底结构的器质性和功能性异常;采用模拟背部垫高、膝髋屈位仰卧的模拟坐位可更真实反映出直肠脱垂或套叠、会阴下降等病理情况,提高MRI诊断成功率。Objective To explore dynamic magnetic resonance imaging defecography in etiological diagnosis of outlet obstruction constipation with changes in position. Methods 16 patients, who presented the varying degree of constipation and diagnosed with outlet obstruction constipation by X-ray defecography, all underwent the examina- tion of dynamic MRI defeeography. Dynamic images capturing was performed by continuous scanning on midsagittal FIESTA images. The defeeography MRI findings achieved in supine and supine-knee hip flexion position respec- tively at 1st day and 3rd day were analyzed comparatively. Results The supine MRI defecography of 16 patients showed 6 patients with rectoceles, 5 rectal prolapses and intussusceptions, 1 puborectal muscle syndrome, 3 pelvic floor hernias, 2 retroversions, 3 cystoceles, 1 uterine prolapse, and 4 descending perineum syndromes. Meanwhile, the supine-knee hip flexion MRI defecography showed 7 patients with rectoceles, 9 rectal prolapses and intussus- ceptions, 1 puborectal muscle syndrome, 4 pelvic floor hernias, 2 retroversions, 3 cystoceles, 1 descending rectum, and 7 descending perineum syndromes. By comparision the outcomes from the dynamic MRI defecography in etio- logical diagnosis of OOC in two positons, the position of supine-knee hip flexion has its advantages in the diagnosis of rectal prolapse or intussusception, descending perineum than the position of supine. Conclusion Dynamic MRI defecography represents dynamic imaging of pelvic floor organs, aiming to elucidate the anatomic and functional background of pelvic floor disorders. By means of the analog position of back booster and supine-knee hip flexion dynamic MRI defecography may truely reflect the pathological disorders of rectal prolapse or intussusception, descending perineum which improves its diagnostic accuracy rate.

关 键 词：排粪造影 磁共振 出口梗阻型便秘 体位 

分 类 号：R445.2[医药卫生—影像医学与核医学]