MRI在肛直肠畸形术后排便障碍中的应用价值

Role of MRI in defecatory dysfunction after anorectai malformation procedure

目的提高对MRI诊断肛直肠畸形术后排便障碍价值的认识，为进一步治疗提供参考。方法以临床检查及术中所见为参照，回顾性分析2009年8月至2011年7月34例肛直肠畸形术后排便障碍患儿的MR图像，分别评价其术后肛直肠的形态及位置、盆底肌的发育状况及伴随的术后改变。结果在21例先天性肛门闭锁、4例Currarino三联症和2例泄殖腔畸形术后排便障碍的患儿中，发现25例盆底肌发育不良，其中21例合并骶尾骨发育不良；21例肛门及直肠周围广泛瘢痕形成；14例直肠扩张，其中3例合并直肠后突，2例合并直肠前突；直肠狭窄6例；8例并发腹膜脂肪疝；6例肛直角增大；3例直肠下段偏移，2例未位于括约肌复合体环内；以前手术遗漏直肠尿道瘘3例；脊髓栓系4例。而在6例先天性巨结肠及1例乙状结肠闭锁术后发生排便困难的患儿中，盆底肌及骶尾骨均发育良好；6例表现为直肠轻中度扩张；1例腹膜脂肪疝。结论MRI对于肛直肠畸形术后排便障碍的患儿具有重要应用价值，能对进一步治疗及预后提供可靠信息。

Objective To assess the value of MRI in postoperative defecatory dysfunction after anorectal malformation （ARM） procedure, and provide further experiences for following studies. Methods MRI findings from 34 patients with postoperative defecatory dysfunction after ARM proce- dure were targeted and retrospective analysis was conduced to evaluate the postoperative morphology of anorectum.developmental status of pelvic floor musculature and other associated pathological chan- ges. Results All patients included 21 cases with congenital imperforate anus, 4 cases with Currarino syndrome and 2 with cloaca malformation. Among them dysplasia of pelvic floor musculature could be found in 25 cases, 21 cases were associated with sacral deficiency, severe scar around anus and rectum were seen in them; Furthermore, 14 cases of rectal dilations and 3 cases of posterior rectoceles, as well as 2 cases of anterior rectoceles were also found; 6 cases of rectal stenosis, 8 cases of peritoneal fat hernias and 6 cases associated with increased anorectal angles were observed; Moreover, 3 cases of lower displacement of rectum and 2 of them dislocated from sphincter complex; Among all 3 cases was caused due to omitting of pre-exist recto-urethral fistulas and 4 case of tethered cords were presented on MR images. However, better development of pelvic floor musculature and sacrum were seen in 6 cased of HSCR and 1 case of sigmoid atresia respectively, although they presented mild-moderate rec- tal dilation and 1 of them was associated with peritoneal fat hernia. Conclusions MRI played important roles in formation provision for ARM postoperative defecatory dysfunction populations.