基于经会阴超声及肛管直肠测压分析女性排便梗阻综合征患者盆底形态与功能特征

Analysis of pelvic floor morphology and functional characteristics of female patients with obstructed defecation syndrome based on transperineal ultrasound and anorectal manometry

目的通过经会阴超声(TPUS)和高分辨率肛管直肠测压(HR-ARM)分析女性排便梗阻综合征(ODS)患者盆底形态及功能特征。方法对2019年6月至2021年12月于南京市中医院肛肠科就诊的117例女性ODS患者的TPUS和HR-ARM结果进行回顾性分析,分别对其直肠前突(RC)、直肠黏膜内套叠(RI)、肠疝、会阴下降、不协调性排便(DD)以及肛管直肠压力测定结果进行评估。结果TPUS诊断排便障碍类型依次为RC+RI 29例(24.8%),DD 14例(12.0%),RC+RI+DD 14例(12.0%)。HR-ARM诊断显示约93.1%的患者在模拟排便过程中存在肛门直肠压力分布异常,占比最大的临床分型为Ⅳ型DD 28例(23.9%),其次是Ⅱ型DD 25例(21.4%)。直肠高敏的患者19例(16.2%),低敏13例(11.1%)。TPUS下常见的结构异常(DD、RC及RI)常同时伴有不同类型肛门直肠协调障碍及直肠感觉功能障碍。结论TPUS与HR-ARM结合能够较好的评估女性ODS患者形态与功能特征,有利于指导临床医师为患者制定更加个体化的治疗方案。

Objective To analyze the morphology and functional characteristics of the pelvic floor in female with obstructed defecation syndrome(ODS)by using transperineal ultrasound(TPUS)and high-resolution anorectal manometry(HR-ARM).Methods From June 2019 to December 2021,the results of TPUS and HR-ARM about 117 female patients with ODS in the Department of Anorectal Diseases of Nanjing Hospital of Traditional Chinese Medicine were retrospectively analyzed,and the results of rectocele,rectal intussusception,enterocele,perineal descent,dyssynergic defecation,and anorectal pressure were evaluated.Results The types of defecation disorder diagnosed by TPUS was rectocele with rectal intussusception(RC+RI)in 29 cases(24.8%),followed by dyssynergic defecation(DD)in 14 cases(12.0%)and RC+RI+DD in 14 cases(12.0%).The results of HR-ARM showed that about 93.1%of patients had abnormal anorectal pressure distribution during simulated bowel movements,and the largest clinical classification was typeⅣDD in 28 cases(23.9%),followed by typeⅡDD in 25 cases(21.4%).There were 19(16.2%)patients with rectal hypersensitivity and 13(11.1%)patients with rectal hyposensitivity.The common structural abnormalities(DD,RC,and RI)diagnosed by TPUS were often accompanied by different types of anorectal coordination disorders and rectal sensory dysfunction.Conclusion The combination of TPUS and HR-ARM can better evaluate the morphological and functional characteristics of female patients with ODS,and is more conducive to guiding clinicians to formulate individualized treatment plans for such patients.