三维超声对耻骨直肠肌变化所致排便障碍的研究

Dyschesia and changes of pubo-rectal angle as observed by 3D ultrasound

目的探讨三维超声检测排便障碍与耻骨直肠肌之间的相关性。方法选取68例排便障碍患者（观察组）和68例健康志愿者（对照组），两组均采用截石位，分别在静息期、力排期和缩肛期行盆底三维超声检查，测量两组耻骨直肠肌后角的大小和肛门截石6点位耻骨直肠肌的厚度。结果①观察组与对照组耻骨直肠肌后角在静息期和缩肛期比较差异无统计学意义[（86±8）°比（86±8）°，t=-0．145，P〉0．05；（88±9）°比（86±7）°，t=0．434，P〉0．05]；在力排期比较差异有统计学意义[（80±6）°比（95±5）°，t=-5．397，P〈0．05]；在静息期与力排期耻骨直肠肌后角的差值为[（6±3）°、（-9±7）°]，两组比较差异有统计学意义（t=5．551，P〈0．05）.②观察组与对照组耻骨直肠肌厚度在静息期为[（4．00±0．35）、（4．01±0．26）mm]、缩肛期为[（3．96±0．44）、（4．16±0．38）mm]，两组比较差异均无统计学意义（t=-0．60、1．177，均P〉0．05）；在力排期比较差异有统计学意义[（4．60±0．60）mm比（3．97±0．32）mm，t=6．872。P〈0．05]；观察组和对照组在静息期与力排期耻骨直肠肌厚度的差值比较差异有统计学意义[（-0．58±0．18）mm比（-0．36±0．21）mm，t=-11．474，P〈0．05]。结论盆底性排便障碍患者的耻骨直肠肌后角在力排期较小，肛门截石6点位耻骨直肠肌厚度较厚，并且静息期与力排期的数值差异越大便秘程度越严重。

Objective To discuss the relativity of dysehesia with the change of puborectalismuscle. Methods 68 patients with dyschesia were compared with 68 healthy volunteers at lithotomy position undergoing 3D uhrasonography on resting, contracting and maximum exertion phase respectively. Three dimensionally reconstructed images were reconstructed and pubo-rectal angle and the thickness of puborectalis muscle at 6 o＇clock position were measured. Results The pubo-reetal angle of the study group and control group had no significant differences at either resting [ （ 86 ±8 ）° vs. （ 86 ±8 ）° ] or contracting phases[ （88 ± 9 ） ° vs. （ 86 -± 7 ）° ] （ t = - 0. 145, t = 0. 434, P 〉 0. 05 ）. While at maximum exertion the differences were significant [ （ 80 ± 6） °vs. （95 ± 5）°, t = - 5. 397,P 〈 0. 05 ]. The d-value of pubo-reetal angle between maximum and resting exertion statistically different [ （ 6 ± 3 ） °, （ - 9 ± 7 ）°, t = 5. 551, P 〈 0. 05 ]. The thickness of puborectalis muscle between the two groups differed statistically significant only at maximum exertion phase [ （4.60 ± 0. 60 ）mm vs. （ 3.97 ± 0. 32 ） ram, t = 6. 872, P 〈 0.05 ]. The d-value of the thickness of puborectalis muscle between maximum and resting exertion were statistically different （ t = - 11. 474, P 〈 0.05 ）. Conclusions The pubo-rectal angle of the study group is smaller at maximum exertion than the control group. The thickness of puborectalis muscle at six o＇ clock （lithotomy position） in study group is larger at maximum exertion than the control group. And the severity of constipation changed with the variation of angle.