排粪造影结合盆腔膀胱造影对出口梗阻性便秘病因诊断的意义

Significance of simultaneous pelvicography and colpocystodefecography for diagnosing causes of outlet obstructive constipation

目的 研究出口梗阻性便秘 (OOC)病人盆腔器官及盆底形态结构变化。方法 对 38例OOC病人及 1 2例正常自愿受试者行排粪造影结合盆腔、膀胱造影 ,女性阴道内放置浸钡标志物 (以下简称“多重造影”)。测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果 多重造影诊断直肠内脱垂 37例 ,直肠前突 5例 ,盆底痉挛综合征 5例 ,物理检查拟诊分别为 1 2例、4例、1例 ,均1 0 0 %得到证实。多重造影检查还发现盆底及腹膜疝 9例 ,膀胱脱出 6例 ,会阴下降综合征 3例 ,子宫后倒或脱垂 1 0例。与对照组相比 ,OOC组力排相肛直角增大 ,静息相及力排相会阴异常下降 ,力排相Douglas陷凹加深 ;OOC组中有泌尿系症状者 ,静息相及力排相膀胱异常下降。结论 多重造影诊断直肠内脱垂和直肠前突的阳性率明显高于物理诊断 ;而且对临床隐匿、物理检查难以诊断的盆底及腹膜疝、膀胱及子宫、阴道脱出等提供了形象客观的诊断依据 ,提高了诊断的准确性 。

Objective To investigate the morphological and structural changes of pelvic floor and corresponding viscera in patients with outlet obstructive constipation (OOC). Methods Simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification for females, voiding cystography and defecography were performed on 38 patients with OCC and 12 healthy volunteers. Anorectal angle, and levels of perineum, peritoneum and bladder were measured. Results PCCD diagnosed 37 internal rectal prolapse (IRP), 5 rectocele (RC) and 5 spastic pelvic floor syndrome (SPFS). Common physical examinations indicated 12 IRP, 4 RC and 1 SPFS, and all of these were confirmed by PCCD. Moreover, PCCD found 9 pelvic floor hernia or peritoneoceles, 6 cystoceles, 3 descending perineum syndromes, and 10 uterine prolapses. Compared with controls, OOC patients had a significantly large anorectal angle during defecation, abnormal descending of perineum at rest and defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms had an abnormal descent of bladder during rest and defecation. Conclusion PCCD has a higher positive ratio than common physical examinations in diagnosis of IRP and RC, and provides some informations for diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine. PCCD is helpful in the selection of a proper surgical procedure. of pelvic floor.