超声剪切波弹性成像评估功能性排便障碍的潜在价值

The potential value of ultrasound shear wave elastography in assessing functional defecation disorders

目的初步探索超声剪切波弹性成像相较于X线排粪造影、肛门直肠测压对评估功能性排便障碍的应用价值。方法回顾性分析2022年7至12月在浙江大学医学院附属邵逸夫医院就诊的39例功能性排便障碍患者的肛门直肠肌群超声剪切波弹性成像、X线排粪造影和肛门直肠测压结果。采用非参数检验比较不同时相肛门直肠肌群弹性模量值的变化。分别运用卡方检验及Bland-Altman点图分析对超声剪切波弹性成像、X线排粪造影和肛门直肠测压评估盆底肌痉挛综合征,以及超声剪切波弹性成像与排粪造影测量的肛直角角度变化[静息相到收缩相,静息相到力排相(Valsalval动作下)]进行一致性检验。结果超声剪切波弹性成像测得功能性排便障碍患者力排相耻骨直肠肌、肛门内括约肌、肛门外括约肌弹性模量值分别为32.4 kPa(19.1 kPa,60.3 kPa)、25.3 kPa(17.0 kPa,53.8 kPa)、28.6 kPa(21.3 kPa,55.1 kPa),分别与静息相弹性模量值[33.5 kPa(22.1 kPa,44.9 kPa)、28.9 kPa(22.4 kPa,45.1 kPa)、32.4 kPa(23.1 kPa,49.4 kPa)]比较,差异均无统计学意义(均P>0.05)。超声剪切波弹性成像和X线排粪造影对于盆底肌痉挛综合征诊断的一致性较差(Kappa值=0.190)。超声剪切波弹性成像和肛门直肠测压对于排便不协调诊断的一致性较差(Kappa值=0.160)。超声剪切波弹性成像与X线排粪造影测量的肛直角角度变化差异值均在95%一致性界限内(P=0.429、0.582)。结论超声剪切波弹性成像评估肛直角角度变化较灵敏,与X线排粪造影评估角度变化一致性较好。

Objective To preliminary explore the potential application value of ultrasound shear wave elastography(SWE)in assessing functional defecation disorders compared with anorectal manometry and X-ray defecography.Methods From July 2022 to December 2022,the results of SWE,anorectal manometry and X-ray defecography of 39 patients with functional defecation disorders visited Sir Run Run Shaw Hospital,School of Medicine of Zhejiang University were retrospectively analyzed.Non-parametric tests were used to analyze the changes in elastic modulus values of anorectal muscle groups at different phase.Chi-square test and Bland-Altman plots were used to assess the consistency between SWE,X-ray defecography and anorectal manometry in evaluating spastic pelvic floor syndrome,as well as the changes in the anorectal angle measured by SWE and X-ray defecography(from resting phase to contraction phase,resting phase to strain phase(Valsalval maneuver).Results The elastic modulus values measured by SWE of the puborectalis muscle,internal anal sphincter,and external anal sphincter of patients with functional defecation disorders during strain phase were 32.4 kPa(19.1 kPa,60.3 kPa),25.3 kPa(17.0 kPa,53.8 kPa),and 28.6 kPa(21.3 kPa,55.1 kPa),respectively,which had no statistically significant differences compared to elastic modulus values in resting phase(33.5 kPa(22.1 kPa,44.9 kPa),28.9 kPa(22.4 kPa,45.1 kPa),and 32.4 kPa(23.1 kPa,49.4 kPa),all P>0.05).The consistency between SWE and X-ray defecography in the diagnosis of spastic pelvic floor syndrome was poor(Kappa=0.190).The consistency between SWE and anorectal manometry in the diagnosis of dyssynergic defecation was poor(Kappa=0.160).The differences in the changes of anorectal angle detected by SWE and X-ray defecography were within the 95%consistency limit(P=0.429 and 0.582).Conclusion SWE is sensitive in evaluating changes in anorectal angle,and it shows good consistency with defecography in assessing angle changes.