盆腔多重造影对慢传输型便秘合并出口梗阻患者手术疗效的评价

Evaluation of surgical outcomes using imaging study for patients with slow transit constipation complicated with outlet obstruction

目的 探讨盆腔多重造影对慢传输型便秘合并出口梗阻患者手术疗效评价的临床意义.方法 通过结肠传输实验筛选,经盆腔多重造影诊断慢传输型便秘伴有出口梗阻的患者48例,针对不同的病因实施外科手术.术后1个月行盆腔多重造影,分别测量术前和术后的肛直角、会阴位置、盆底腹膜位置和膀胱位置,观察脏器相互位置改变及排粪梗阻解除的影像学表现.结果 48例患者根据术前的盆腔多重造影检查结果分别施行直肠前突修补术、直肠黏膜部分切除加固定术和子宫悬吊术等手术,术后全部获得6～58（平均19）个月的随访,46例（95.8%）患者术后排粪频率平均1.9次/d.影像学测量结果：肛直角变化（度）：术前力排相和差值分别为128.09±13.82和11.14±12.58,术后则分别为180.26±9.98和20.01±13.11（P＜0.05） 会阴位置变化（cm）：术前力排相和差值分别为-2.05±0.83和2.23±0.78,术后则分别为-0.50±1.13和2.18±1.04（P＜0.05） 盆底腹膜位置（cm）：术前力排相和差值分别为4.91±1.32和1.32±0.89,术后则分别为2.62±2.53和3.28±0.68（P＜0.05） 膀胱位置（cm）：有泌尿系症状者术前力排相和差值分别为3.92±2.51和1.39±1.27,术后则分别为2.15±1.55和1.98±1.54（P＜0.05） 差异均具有统计学意义.结论 盆腔多重造影对慢传输型便秘合并出口梗阻患者的手术疗效能提供客观的分析依据和评价手段.

Objective To explore the clinical significance of multiple radiography of the pelvis in the evaluation of surgical outcomes for patients with slow transit constipation complicated with outlet obstruction. Methods Patients with slow transit constipation complicated with outlet obstruction were diagnosed by multiple radiography of the pelvis after screening using colon transit study. Surgery was performed according to the cause of the obstruction. Anorectal angle and the locations of perineum, pelvic peritoneum, and bladder were assessed by multiple radiography of the pelvis one month after surgery. The changes in locations of pelvic organs were assessed and the imaging appearance after the release of obstruction was observed. Results A total of 48 patients were included. Rectocele repair, partial mucosectomy with rectopexy, and hysteropexy were performed. All the patients were followed up with a mean length of 19（6-58） months. Excluding 2 patients who had no symptomatic improvement, the mean bowel movements was 1.9 times per day in the remaining 46 patients（95.8%）. Preoperative anorectal angle at the squeezing phase was（128.09±13.82） degree and the difference between squeezing and resting phase was （11.14±12.58） degree, while the postoperative angle was （180.26±9.98） degree and the difference（20.01±13.11） degree（P〈0.05）. Preoperative location of the perineum at the squeezing phase was（-2.05±0.83） cm and the difference was（2.23±0.78） cm, while postoperative location was （-0.50±1.13） cm and the difference was （2.18±1.04） cm（P〈0.05）. Preoperative location of the pelvic peritoneum at the squeezing phase was（4.91±1.32） cm and the difference was （1.32±0.89） cm, while postoperative location was （2.62±2.53） cm and the difference was （3.28±0.68） cm （P〈0.05）. Preoperative bladder location at the squeezing phase in patients with urological symptoms was （3.92±2.51） cm and the difference was（1.39±1.27） cm, while postoperative location was （2.15±1.55） cm and the difference was （1.98±1.54） cm（P〈0.05）. Conclusion Multiple imaging of the pelvis provides objective evidence in the evaluation of surgical outcomes for patients with chronic slow transit constipation complicated with outlet obstruction.