经会阴直肠超声可否用于直肠前突的诊断?

Is the transperineal ultrasonography approach effective for the diagnosis of rectocele?

背景:经会阴直肠超声在直肠前突影像学诊断方面的应用已有多年,但其与排粪造影在评估直肠前突严重程度上的一致性并不理想。本研究旨在评估这两种方法评估直肠前突相关参数的一致性,从而为直肠前突的临床诊断提供思路。方法:这项初步研究招募了一家三甲医院2017年12月至2019年12月间的门诊直肠前突患者,分别于左侧卧位、蹲位和立位进行排粪造影检查,再分别于左侧卧位、蹲位和立位进行经会阴超声检查。评估两种检查方法的结果一致性。结果:30例女性直肠前突患者纳入研究。相比蹲位,采用立位进行排粪造影检查,无论静坐、提肛、Valsalva动作还是排便时,肛直角均明显增大;在Valsalva动作和排便时,前突深度加深;提肛和Valsalva动作时,会阴下降程度增加。而采用立位、蹲位和左侧卧位进行经会阴直肠超声检查,肛直角、前突深度、提肛间隙面积以及前突体积均明显不同。Bland-Altman半定量图显示,无论是采用蹲位还是立位,排粪造影与经会阴超声所测量出的肛直角和前突深度均有较好的一致性。结论:本研究结果为经会阴超声用于直肠前突患者的影像学评估提供了初步的证据支持,检查时宜采用蹲位和立位。

Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory.This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.Methods In this pilot study,participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019.All participants separately underwent defecation proctography at sitting and squatting positions,and undertook transperineal ultrasonography at left lateral,sitting,and squatting positions.The consistency of ultrasonography and defecography was evaluated.Results Thirty female volunteers with rectocele were included in this study.The degree of anorectal angle was significantly larger at rest and during contraction,maximal Valsalva,and evacuation;the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation;and the length of the perineumdescending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography.The degree of anorectal angle,the depth of rectocele,the area of levator hiatus,and the volume of the rectocele were significantly different in using squatting,sitting,and left lateral positions when performing the transperineal ultrasonography.Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.