X线排粪造影与多参数盆底动态MRI对盆底痉挛综合征及其相关的复合型病变的诊断价值研究  

Diagnostic value of X-ray defecography and Multi-parameter pelvic floor dynamicsc MRI for spastic pelvic floor syndrome and its associated complex lesions

作　　者：丁俞江 王永兵[2] 李刚[2] 谢禹昌[1] 陆燕[1] 王煜莹[3] Ding Yujiang;Wang Yongbing;Li Gang;Xie Yuchang;Lu Yan;Wang Yuying(Pudong New Area People’s Hospital, Shanghai 201299, China;Department of Anorectal Surgery;Department of Chinese Rectum, Pudong New Area People’s Hospital, Shanghai 201299, China)

机构地区：[1]上海市浦东新区人民医院影像科,上海201299 [2]上海市浦东新区人民医院肛肠外科,上海201299 [3]上海市浦东新区人民医院中医肛肠科,上海201299

出　　处：《结直肠肛门外科》2019年第4期462-465,共4页Journal of Colorectal & Anal Surgery

基　　金：上海市卫生计生委科研课题（201540418）;上海市浦东新区重点学科（PWZxk2017-11）

摘　　要：目的探讨X线排粪造影与多参数盆底动态MRI对盆底痉挛综合征(SPFS)及其相关的复合型病变的诊断价值。方法对X线排粪造影诊断为盆底痉挛综合征的26例患者进行多参数盆底动态MRI检查,并对比分析X线和MRI的测量数据及相关的复合型病变的诊断结果。结果两种方法测量耻骨直肠肌痉挛压迹(PRMI)力排长度、肛直角静息值、肛直角力排值、肛直角改变值结果比较,差异均无统计学意义(均P> 0.05)。X线测量PRMI深度为(32.86±8.78) mm,较MRI测量的深度(28.86±7.61) mm大,差异有统计学意义(P <0.05)。对两种方法诊断26例SPFS患者相关的复合型病变的结果进行一致性分析发现:在诊断SPFS伴会阴下降(PD)存在较高的一致性,Kappa值为0.866;在诊断耻骨直肠肌肥厚症(PRMH)、SPFS伴直肠前突(RC)的一致性较好,Kappa值分别为0.606、0.698;诊断SPFS伴小肠疝(EC)或乙状结肠疝(SC)的一致性较差,Kappa值为0.288;MRI在诊断SPFS伴内脏下垂(SP)时有优势,检出病例6例,X线排粪造影未检出相应病例。结论两种方法均可用于诊断SPFS,且在诊断SPFS伴PD、PRMH、SPFS伴RC有较高一致性,多参数盆底动态MRI分辨率更高,可以作为诊断盆底痉挛综合征及其相关的复合型病变的补充。Objectives To investigate the value of X-ray defecography and Multi-parameter pelvic floor dynamics MRI in diagnosing spastic pelvic floor syndrome(SPFS) and related disorders. Methods Twenty-six patients who were diagnosed with SPFS by X-ray defecography received Multi-parameter pelvic floor dynamicsc MRI. We compared parameters obtained by X-ray defecography and MRI and analyzed their value in diagnosing related disorders of the pelvic floor. Results There was no significant difference in length of puborectalis muscle impression(PRMI), anorectal angle(ARA) at evacuation phase, and change of ARA between X-ray defecography and MRI(P > 0.05). The depth of PRMI measured by X-ray defecography(32.86±8.78) was significantly larger than that measured by MRI(28.86±7.61, P < 0.05). Analyses of the two imaging techniques in diagnosing SPFS related disorders showed high consistency in diagnosing SPFS concomitant with perineum descending(kappa =0.866), good consistency in puborectalis muscle hypertrophy with rectocele(kappa = 0.606) and SPFS with rectocele(kappa = 0.698), but poor consistency in SPFS with enterocele or sigmoicele(kappa = 0.288). MRI showed advantage in diagnosing SPFS with splanchnoptosis.Six cases were diagnosed with MRI, while none with X-ray defecography. Conclusion Both X-ray defecography and MRI could be used in diagnosing SPFS. They have good consistency in diagnosing SPFS with perineum descending, puborectalis muscle hypertrophy, and SPFS with rectocele. Multi-parameter pelvic floor dynamicsc MRI can achieve higher resolution and could be used as secondary modality at diagnosing SPFS and related disorders of the pelvic floor.

关 键 词：盆底痉挛综合征 X线排粪造影 多参数盆底动态MRI 

分 类 号：R657.1[医药卫生—外科学]