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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 229 -234. doi: 10.3877/cma.j.issn.2095-2015.2024.03.009

论著

基于经会阴超声及肛管直肠测压分析女性排便梗阻综合征患者盆底形态与功能特征
李婧婧1, 陈茜2, 周惠芬2, 曾禹沙1, 许新意1, 樊志敏2, 薛雅红2,()   
  1. 1. 210023 南京中医药大学研究生院
    2. 210001 南京中医药大学附属南京市中医院肛肠科
  • 收稿日期:2023-11-19 出版日期:2024-06-01
  • 通信作者: 薛雅红
  • 基金资助:
    江苏省中医肛肠疾病临床医学创新中心项目支持(GCCXZX-2021); 第七批全国老中医药专家学术经验继承工作(2022-GQPSC-XYH)

Analysis of pelvic floor morphology and functional characteristics of female patients with obstructed defecation syndrome based on transperineal ultrasound and anorectal manometry

Jingjing Li1, Qian Chen2, Huifen Zhou2, Yusha Zeng1, Xinyi Xu1, Zhimin Fan2, Yahong Xue2,()   

  1. 1. Graduate School, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, China
    2. Department of Anorectal Diseases, Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 210001, China
  • Received:2023-11-19 Published:2024-06-01
  • Corresponding author: Yahong Xue
引用本文:

李婧婧, 陈茜, 周惠芬, 曾禹沙, 许新意, 樊志敏, 薛雅红. 基于经会阴超声及肛管直肠测压分析女性排便梗阻综合征患者盆底形态与功能特征[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 229-234.

Jingjing Li, Qian Chen, Huifen Zhou, Yusha Zeng, Xinyi Xu, Zhimin Fan, Yahong Xue. Analysis of pelvic floor morphology and functional characteristics of female patients with obstructed defecation syndrome based on transperineal ultrasound and anorectal manometry[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(03): 229-234.

目的

通过经会阴超声(TPUS)和高分辨率肛管直肠测压(HR-ARM)分析女性排便梗阻综合征(ODS)患者盆底形态及功能特征。

方法

对2019年6月至2021年12月于南京市中医院肛肠科就诊的117例女性ODS患者的TPUS和HR-ARM结果进行回顾性分析,分别对其直肠前突(RC)、直肠黏膜内套叠(RI)、肠疝、会阴下降、不协调性排便(DD)以及肛管直肠压力测定结果进行评估。

结果

TPUS诊断排便障碍类型依次为RC+RI 29例(24.8%),DD 14例(12.0%),RC+RI+DD 14例(12.0%)。HR-ARM诊断显示约93.1%的患者在模拟排便过程中存在肛门直肠压力分布异常,占比最大的临床分型为Ⅳ型DD 28例(23.9%),其次是Ⅱ型DD 25例(21.4%)。直肠高敏的患者19例(16.2%),低敏13例(11.1%)。TPUS下常见的结构异常(DD、RC及RI)常同时伴有不同类型肛门直肠协调障碍及直肠感觉功能障碍。

结论

TPUS与HR-ARM结合能够较好的评估女性ODS患者形态与功能特征,有利于指导临床医师为患者制定更加个体化的治疗方案。

Objective

To analyze the morphology and functional characteristics of the pelvic floor in female with obstructed defecation syndrome (ODS) by using transperineal ultrasound (TPUS) and high-resolution anorectal manometry (HR-ARM).

Methods

From June 2019 to December 2021, the results of TPUS and HR-ARM about 117 female patients with ODS in the Department of Anorectal Diseases of Nanjing Hospital of Traditional Chinese Medicine were retrospectively analyzed, and the results of rectocele, rectal intussusception, enterocele, perineal descent, dyssynergic defecation, and anorectal pressure were evaluated.

Results

The types of defecation disorder diagnosed by TPUS was rectocele with rectal intussusception (RC+RI) in 29 cases (24.8%), followed by dyssynergic defecation (DD) in 14 cases (12.0%) and RC+RI+DD in 14 cases (12.0%). The results of HR-ARM showed that about 93.1% of patients had abnormal anorectal pressure distribution during simulated bowel movements, and the largest clinical classification was type Ⅳ DD in 28 cases (23.9%), followed by type Ⅱ DD in 25 cases (21.4%). There were 19 (16.2%) patients with rectal hypersensitivity and 13 (11.1%) patients with rectal hyposensitivity. The common structural abnormalities (DD, RC, and RI) diagnosed by TPUS were often accompanied by different types of anorectal coordination disorders and rectal sensory dysfunction.

Conclusion

The combination of TPUS and HR-ARM can better evaluate the morphological and functional characteristics of female patients with ODS, and is more conducive to guiding clinicians to formulate individualized treatment plans for such patients.

图1 力排状态下经会阴超声表现注:ARA肛直角;R直肠;A肛管;RI直肠黏膜内套叠;RC直肠前突;B膀胱;P耻骨联合。
图2 高分辨率肛管直肠测压显示直肠肛门协调障碍分型[18]
表1 女性排便梗阻综合征患者经会阴超声特征(n=117)
图3 女性排便梗阻综合征患者高分辨率肛管直肠测压特征(n=117)
表2 TPUS与HR-ARM相结合分析[例(%)]
[1]
Sultan AH, Monga A, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction[J]. Int Urogynecol J, 2017, 28(1): 5-31.
[2]
Aubert M, Mege D, Le Huu NR, et al. Surgical management of the rectocele - An update[J]. J Visc Surg, 2021, 158(2): 145-157.
[3]
Noelting J, Eaton JE, Choung RS, et al. The incidence rate and characteristics of clinically diagnosed defecatory disorders in the community[J]. Neurogastroenterol Motil, 2016, 28(11): 1690-1697.
[4]
Racaniello E, Terzoni S, Accardi R, et al. Quality of life of patients undergoing surgery for obstructed defecation syndrome: A before-after study[J]. Int J Surg, 2015, 21: 18-21.
[5]
Santoro GA, Wieczorek AP, Dietz HP, et al. State of the art: an integrated approach to pelvic floor ultrasonography[J]. Ultrasound Obstet Gynecol, 2011, 37(4): 381-396.
[6]
Martellucci J, Brusciano L. The Dynamic Transperineal Ultrasound Era of the Evaluation of Obstructed Defecation Syndrome[J]. Dis Colon Rectum, 2016, 59(8): 800-803.
[7]
Grossi U, Carrington EV, Bharucha AE, et al. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation[J]. Gut, 2016, 65(3): 447-455.
[8]
Bharucha AE, Basilisco G, Malcolm A, et al. Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test[J]. Neurogastroenterol Motil, 2022, 34(9): e14335.
[9]
Rao S, Hasler WL. Can high-resolution anorectal manometry shed new light on defecatory disorders?[J]. Gastroenterology, 2013, 144(2): 263-265.
[10]
Podzemny V, Pescatori LC, Pescatori M. Management of obstructed defecation[J]. World J Gastroenterol, 2015, 21(4): 1053-1060.
[11]
俞汀, 姜柳琴, 林琳. 功能性便秘的新认识——罗马Ⅳ标准更新点解读[J]. 中华胃肠外科杂志, 2017, 20(12): 1334-1338.
[12]
Kam HA, Yagel S, Eisenberg VH. Ultrasonography in Pelvic Floor Dysfunction[J]. Obstet Gynecol Clin North Am, 2019, 46(4): 715-732.
[13]
Jeong HY, Yang SJ, Cho DH, et al. Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders[J]. Ann Coloproctol, 2020, 36(4): 256-263.
[14]
卢任华. 排粪造影在肛肠外科的应用[J]. 中国实用外科杂志, 2002(12): 6-7.
[15]
Dietz HP, Beer-Gabel M. Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation[J]. Ultrasound Obstet Gynecol, 2012, 40(1): 14-27.
[16]
van Gruting IM, Stankiewicz A, Thakar R, et al. Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome[J]. Cochrane Database Syst Rev, 2021, 9(9): D11482.
[17]
Carrington EV, Heinrich H, Knowles CH, et al. The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function[J]. Neurogastroenterol Motil, 2020, 32(1): e13679.
[18]
Rao SS, Patcharatrakul T. Diagnosis and Treatment of Dyssynergic Defecation[J]. J Neurogastroenterol Motil, 2016, 22(3): 423-435.
[19]
Roberts C, Albusoda A, Farmer AD, et al. Factors influencing rectal hypersensitivity in irritable bowel syndrome: A systematic review and meta-analysis[J]. Neurogastroenterol Motil, 2023, 35(4): e14515.
[20]
Townsend DC, Carrington EV, Grossi U, et al. Pathophysiology of fecal incontinence differs between men and women: a case-matched study in 200 patients[J]. Neurogastroenterol Motil, 2016, 28(10): 1580-1588.
[21]
Vollebregt PF, Burgell RE, Hooper RL, et al. Clinical Impact of Rectal Hyposensitivity: A Cross-Sectional Study of 2, 876 Patients With Refractory Functional Constipation[J]. Am J Gastroenterol, 2021, 116(4): 758-768.
[22]
Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction[J]. Gastroenterology, 2016, 150(6): 1257-1261.
[23]
马雪华, 吴枭. 应用经阴道三维盆底超声参数评价不同分娩方式对女性盆底功能和结构的影响[J]. 中国实用医刊, 2021, 48(8): 11-15.
[24]
Grossi U, Heinrich H, Di Tanna GL, et al. Systematic Characterization of Defecographic Abnormalities in a Consecutive Series of 827 Patients With Chronic Constipation[J]. Dis Colon Rectum, 2021, 64(11): 1385-1397.
[25]
Picciariello A, Rinaldi M, Grossi U, et al. Time trend in the surgical management of obstructed defecation syndrome: a multicenter experience on behalf of the Italian Society of Colorectal Surgery (SICCR)[J]. Tech Coloproctol, 2022, 26(12): 963-971.
[26]
Paquette IM, Varma M, Ternent C, et al. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation[J]. Dis Colon Rectum, 2016, 59(6): 479-492.
[27]
Zarate N, Nseir H, Scott S. Clinical Presentation and Results of Anorectal Physiological Investigation in a Large Cohort of Patients With Rectal Hypersensitivity: Rectal Intussusception and Prolapse-An Overlooked Aetiological Factor?[Z]. Chicago, IL: 2011S799.
[28]
Rao S, Coss-Adame E, Yan Y, et al. Sensory Adaptation Training or Escitalopram for IBS With Constipation and Rectal Hypersensitivity: A Randomized Controlled Trial[J]. Clin Transl Gastroenterol, 2021, 12(7): e381.
[29]
Rao SS, Benninga MA, Bharucha AE, et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders[J]. Neurogastroenterol Motil, 2015, 27(5): 594-609.
[30]
Rao S, Yan Y, Erdogan A, et al. Barostat or syringe-assisted sensory biofeedback training for constipation with rectal hyposensitivity: A randomized controlled trial[J]. Neurogastroenterol Motil, 2022, 34(3): e14226.
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