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中华消化病与影像杂志(电子版) ›› 2023, Vol. 13 ›› Issue (01) : 15 -20. doi: 10.3877/cma.j.issn.2095-2015.2023.01.004

论著

动态经会阴超声对女性排便梗阻综合征诊断价值的研究
薛雅红1, 樊志敏1, 高玲2, 沈广澍2, 岳婧婧2, 姜韵琳3, 王小峰1,()   
  1. 1. 210022 南京中医药大学附属南京中医院肛肠科
    2. 210022 南京中医药大学附属南京中医院影像科
    3. 210029 南京中医药大学中医外科系
  • 收稿日期:2022-11-08 出版日期:2023-02-01
  • 通信作者: 王小峰
  • 基金资助:
    南京市卫生局重点项目(ZKX19035); 江苏省老中医药专家学术经验继承工作(2019-SSPSC-XYH)

Study on the diagnostic value of dynamic transperineal ultrasound in female patients with obstructed defaecation syndrome

Yahong Xue1, Zhimin Fan1, Ling Gao2, Guangshu Shen2, Jingjing Yue2, Yunlin Jiang3, Xiaofeng Wang1,()   

  1. 1. Department of Proctology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, China
    2. Department of Imaging, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, China
    3. Department of Traditional Chinese Medicine Surgery, Nanjing University of Chinese Medicine, Nanjing 210029, China
  • Received:2022-11-08 Published:2023-02-01
  • Corresponding author: Xiaofeng Wang
引用本文:

薛雅红, 樊志敏, 高玲, 沈广澍, 岳婧婧, 姜韵琳, 王小峰. 动态经会阴超声对女性排便梗阻综合征诊断价值的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(01): 15-20.

Yahong Xue, Zhimin Fan, Ling Gao, Guangshu Shen, Jingjing Yue, Yunlin Jiang, Xiaofeng Wang. Study on the diagnostic value of dynamic transperineal ultrasound in female patients with obstructed defaecation syndrome[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(01): 15-20.

目的

以传统X线排粪造影为金标准,评估动态经会阴超声对女性排便梗阻综合征的诊断价值。

方法

回顾性分析2019年6月至2021年12月南京中医药大学附属南京中医院收治97例女性排便梗阻综合征患者资料,患者均接受X线排粪造影和动态经会阴超声检查,分别对直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便进行评估,并对两种影像学的诊断结果进行一致性检验。

结果

动态经会阴超声诊断直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便的灵敏度分别为88%、86%、83%、67%、95%,特异度分别为90%、96%、99%、96%、86%。两种影像学在评估直肠前突分度上显示一致性中等,Kappa系数为0.538;直肠黏膜内套叠、会阴下降和不协调性排便一致性较好,Kappa系数分别为0.727、0.655、0.791;肠疝一致性极好,Kappa系数为0.822。经会阴超声测得静息状态肛直角大于X线排粪造影(121.79±9.54 vs.112.69±11.73,P<0.05)。

结论

动态经会阴超声在诊断女性排便梗阻综合征上显示了较高特异性,是一项有效评估女性排便梗阻综合征的影像学技术。

Objective

To evaluate the value of dynamic transperineal ultrasonography(DTPU)in the diagnosis of female patients with obstructed defaecation syndrome(ODS)using traditional X-ray defecography as the gold standard.

Methods

The data of 97 female patients with ODS admitted to Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from June 2019 to December 2021 were retrospectively analyzed.All patients received X-ray defecography and DTPU to evaluate rectocele(RC), rectal intussusception(RI), enterocele(EC), perineal descent(PD)and dyssynergic defecation(DD), and to test the consistency of the two imaging diagnosis results.

Results

The sensitivities of DTPU in the diagnosis of RC, RI, EC, PD and DD were 88%, 86%, 83%, 67% and 95% respectively, and the specificities were 90%, 96%, 99%, 96% and 86% respectively.The two imaging techniques showed moderate consistency in evaluating the grading of RC, with Kappa coefficient of 0.538.The consistencies of RI, PD and DD were good, with Kappa coefficients of 0.727, 0.655 and 0.791 respectively.The consistency of EC was excellent, and Kappa coefficient was 0.822.The anorectal angle(ARA)measured by DTPU at rest was greater than that of X-ray defecography(121.79±9.54 vs.112.69±11.73, P<0.05).

Conclusion

DTPU shows high specificity in the diagnosis of female ODS and it is an effective imaging technique for evaluating female ODS.

表1 女性排便梗阻综合征患者的临床特征(n=97)
图1 经会阴超声盆底解矢状面显像注:PR耻骨直肠肌;R直肠;A肛管;V阴道;U尿道;P耻骨联合;B膀胱
图2 经会阴超声显示肛直角变化注:①静息95°;②力排84°;R直肠;A肛管;ARA肛直角
图3 两种影像学直肠前突表现注:①排粪造影;②经会阴超声;R直肠;A肛管;RC直肠前突
图4 经会阴超声显示直肠黏膜内套叠注:①直肠-直肠型;②直肠-肛管型;R直肠;A肛管;RI直肠黏膜内套叠
图5 两种影像学肠疝表现注:①排粪造影;②经会阴超声;R直肠;A肛管;V阴道;EC肠疝
表2 女性排便梗阻综合征患者动态经会阴超声检测准确性分析(%,n=97)
表3 女性排便梗阻综合征患者X线排粪造影与动态经会阴超声诊断结果一致性分析(例)
表4 X线排粪造影与动态经会阴超声肛直角检测结果比较(±s)
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