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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

24卷

期数:

2018年03期

页码:

236-240

栏目:

出版日期:

2018-05-20

文章信息/Info

Title:

Diagnostic value of 3D high resolution anorectal manometry for spasticity pelvic floor syndrome

作者:

赵亚婧¹; 2; 潘晓晔¹; 2; 张轶³; 顾程¹; 2; 张春泽³; 王文红²

1.天津医科大学研究生院，天津300070;2.天津市人民医院影像中心，天津300121；3.天津市人民医院肛肠科，天津300121

Author(s):

ZHAO Ya-jing¹; 2; PAN Xiao-ye¹; 2; ZHANG Yi³; GU Cheng¹; 2 ; ZHANG Chun-ze³; WANG Wen-hong²

1.Graduate School, Tianjin Medical University, Tianjin 300070, China; 2.Medical Imaging Center,Tianjin Union Medical Center, Tianjin 300121, China; 3.Anorectal Department, Tianjin Union Medical Center, Tianjin 300121, China

关键词:

盆底痉挛综合征; 3D高分辨率肛门直肠压力测定; 肛肠动力学; 排粪造影

Keywords:

spastic pelvic floor syndrome;  3D high - resolution anorectal manometry;  anorectal dynamics;  defecography

分类号:

R574

DOI:

-

文献标志码:

A

摘要:

目的：探讨3D高分辨率肛门直肠测压技术在诊断盆底痉挛综合征（SPFS）中的应用价值。方法：收集35例符合功能性便秘的罗马Ⅲ诊断标准并行直肠排粪造影诊断为SPFS的患者为SPFS组，另收集31例同期健康志愿者为对照组，其中SPFS组22例及对照组行3D高分辨率肛门直肠测压。观察SPFS组及对照组不同时相下直肠、肛门的形态学及肛肠动力学变化。采用Pearson相关性检验对SPFS组力排相的影像学表现与肛肠动力学变化行相关性分析。结果：（1）SPFS患者力排相及黏膜相时的肛直角[分别为(88.63±2.75) °和(88.41±2.75) °]较静息相均无明显变化甚至变小。在力排相时，SPFS组的耻骨直肠肌切迹的深度与长度分别为（13.06±6.24）mm、（32.20±13.22）mm。（2）SPFS组与对照组的肛管静息压、肛管最大收缩压、肛门括约肌功能长度及肛管残余压之间的差异皆有统计学意义（P<0.05）。SPFS组与对照组的初始感觉阈值、初始排便阈值、最大耐受阈值之间的差异皆有统计学意义（P<0.05）。（3）SPFS组在力排时肛直角与肛管静息压呈负相关（r=-0.521，P=0.013），与初始排便阈值及最大耐受阈值呈正相关（r=0.551，P=0.008；r=0.483，P=0.023）;其肛上距与肛管残余压呈负相关（r=-0.483，P=0.023），与肛管松弛率呈正相关（r=0.687，P=0.000）。结论：3D高分辨率肛门直肠测压可定量观察肛肠动力学变化，为SPFS的诊断及临床治疗手段提供可靠依据，具有一定临床应用价值。

Abstract:

Objective: To investigate the application of 3D high resolution anorectal manometry for spastic pelvic floor syndrome(SPFS). Methods: A total of 35 patients who were diagnosed as SPFS were included in the SPFS group. All patients underwent rectal defecography. Twenty-two patients underwent 3D high-resolution anorectal manometry in SPFS group. Thirty-one healthy volunteers were selected as control group, and 3D high - resolution anorectal manometry was performed. The morphological changes of rectum, anus and anorectal dynamics in SPFS patients were observed at different times and anorectal dynamics in both groups. Pearson correlation test was used to analyze the correlation between the imaging findings of SPFS group and the anorectal dynamics. Results: （1） In SPFS patients, there was no significant change or even decrease in the anorectal angle of force phase and mucous membrane phase [(88.63 ± 2.75 )°, (88.41 ± 2.75) °]. The depth and length of the pubic muscular notch in group SPFS were (13.06 + 6.24) mm and (32.20 + 13.22) mm at the time of force phase. （２） There were significant differences between the SPFS group and the control group in mean resting pressure, maximum squeeze pressure, high pressure zone length, residual anal pressure (P< 0.05). There were significant differences between the SPFS group and the control group in the initial sensory threshold, the initial defecation threshold and the maximum tolerance threshold （P< 0.05）. （3） In group SPFS, anorectal angle was negatively correlated with anal resting pressure（r=-0.521，P=0.013）, and positive correlation with initial defecation threshold and maximal tolerance threshold（r=0.551， P=0.008； r=0.483， P=0.023）. Distance between the anorecal junction and the pubococcygeal line was negatively correlated with residual anal pressure （r=-0.483，P=0.023）and positively correlated with anal relaxation rate （r=0.687，P=0.000）.Conclusion: 3D high resolution anorectal manometry can quantitatively observe the change of anorectal dynamics. And it can provide a reliable diagnostic basis for the diagnosis of SPFS. It is a pelvic floor functional imaging technology with high clinical application value.

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备注/Memo

备注/Memo:

文章编号 1006-8147(2018)03-0236-05

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更新日期/Last Update: 2018-05-20