磁共振联合排粪造影对诊断盆底改变所致直肠型便秘的作用

Magnetic resonance imaging combined with defecograph on the diagnosis of rectal constipation caused by plevic floor changes

目的:采用磁共振(MRI)联合排粪造影检查(DFG)及Wexner便秘量化评分分析耻骨直肠肌厚度及后角角度的改变对直肠型便秘的影响。方法:随机选取2021年7—9月山东第一医科大学第一附属医院肛肠科收治的50例直肠性便秘患者为观察组,同期招募50例健康志愿者为对照组。观察组行Wexner便秘量化评分,两组均行盆底MRI及DFG检查,测量在静息期和力排期状态下患者左右侧耻骨直肠肌厚度差值(△PUB-T)及后角角度差值(△PUB-PA)。结果:在静息和力排状态下,观察组与对照组耻骨直肠肌左侧(截石3点位)厚度差值(△L-PUB-T)分别为(-0.74±0.88)mm和(-1.86±0.84)mm;耻骨直肠肌右侧(截石9点位)厚度差值(△R-PUB-T)分别为(-1.50±1.07)mm和(-2.54±1.19)mm;△PUB-PA为(-1.34±3.61)°和(2.44±2.67)°;差异均有统计学意义(P<0.05)。观察组在两种状态下△L-PUB-T与Wexner便秘量化评分呈正相关(R^(2)=0.9297,t=25.117,P<0.001),△R-PUB-T与Wexner便秘量化评分呈正相关(R^(2)=0.8408,t=15.926,P<0.001),△PUB-PA与Wexner便秘量化评分呈负相关(R^(2)=0.9279,t=24.756,P<0.001)。结论:MRI联合排粪造影技术可动静态观察直肠性便秘患者左右耻骨直肠肌厚度和后角角度的变化,为直肠型便秘的精准化诊治提供客观依据。

Objective:Magnetic resonance imaging combined with defecography(DFG)and Wexner constipation quantitative score were used to analyze the influence of changes in the thickness of puborectalis muscle and the angle of the posterior angleon rectal constipation.Methods:Fifty patients with rectal constipation treated in the First Affiliated Hospital of Shandong First Medical University from July 2021 to September 2021 were randomly selected as the observation group,and50 healthy volunteers were recruited as the control group during the same period.Wexner constipation quantitative score was performed in the observation group,pelvic floor magnetic resonance imaging and defecography were performed in both groups,and the thickness difference between left and right sides of the puborectalis muscle(△PUB-T)and the angle difference between the angle of posterior angle(△PUB-PA)were measured during the resting period and the force release period.Results:The thickness difference on the left side of the rectal muscle(lithotomy position 3 points)(△L-PUB-T)between the observation group and the control group was(-0.74±0.88)mm and(-1.86±0.84)mm,and the difference was statistically significant(P<0.05).The thickness difference on the left side of the rectal muscle(lithotomy position 3 points)(△R-PUB-T)between the observation group and the control group was(-1.50±1.07)mm and(-2.54±1.19)mm,and the difference was statistically significant(P<0.05).The angle difference of posterior angle of puborectalis muscle(△PUB-PA)between the observation group and the control group was(-1.34±3.61)°and(2.44±2.67)°at rest and force platoon,and the difference was statistically significant(P<0.05).In the observation group,there was a positive correlation between the thickness difference of left puborectalis muscle(△L-PUB-T)and Wexner constipation quantitative score(R^(2)=0.9297,t=25.117,P<0.001).The thickness difference of right puborectalis muscle(△R-PUB-T)was positively correlated with Wexner constipation quantitative score(R^(2)=0.8408,t=15.926,P<0.001).The angle difference of posterior angle of puborectalis muscle(△PUB-PA)was negatively correlated with Wexner constipation quantitative score(R^(2)=0.9279,t=24.756,P<0.001).Conclusion:Magnetic resonance imaging combined with defecography can observe the changes of left and right puborectalis muscle thickness and the angle of the posterior angle in patients with rectal constipation dynamically and statically,providing objective basis for accurate diagnosis and treatment of rectal constipation.