盆底四维超声量化评估后盆腔异常在女性出口梗阻型便秘诊断中的价值

The value of quantitative evaluation of pelvic floor four-dimensional ultrasound in the diagnosis of female outlet obstructive constipation

目的 探讨盆底四维超声测量肛直角(ARA)大小及肛提肌裂孔面积(LH)量化评估后盆腔异常在女性出口梗阻型便秘(OOC)诊断中的应用价值。方法 前瞻性选取宝鸡市中心医院消化内科及肛肠外科因便秘就诊,盆底四维超声诊断为后盆腔异常且符合出口梗阻型便秘的女性患者142例为研究组,68名健康体检者为对照组,应用盆底四维超声在静息状态和Vasvala状态下分别测量ARA大小;观察直肠壶腹在静息状态及Vasvala状态的位置变化;并在Vasvala状态测量最大LH面积,将2组的测量数据进行对比分析。结果 静息状态时研究组中ARA大小为(116±10)°,对照组ARA大小为(107±11)°,差异有统计学意义(t=5.37,P<0.05)。Valsalva动作时,研究组ARA大小为(107±10)°,较静息状态变小;对照组ARA大小为(119±11)°,较静息状态增大,差异有统计学意义(t=-7.92,P<0.05);Valsalva动作时研究组最大LH面积为(31.5±6.1)cm^(2),对照组为(20.0±2.4)cm^(2),研究组大于对照组,2组比较差异无统计学意义(t=18.97,P<0.05)。研究组分型中,静息状态下直肠前突者ARA大小为(116±10)°,会阴体过度运动者ARA大小为(116±10)°,2组比较差异无统计学意义(t=-0.034,P>0.05);Valsalva动作下直肠前突者ARA大小为(105±11)°,较静息状态减小;会阴体过度运动者ARA大小为(108±9)°,较静息状态减小。Valsalva动作下直肠前突者的ARA略小于会阴体过度运动者,二者差异有统计学意义(t=-1.32,P<0.10);Valsalva动作下直肠前突者LH最大面积(32.4±6.2)cm^(2),会阴体过度运动者LH最大面积(30.7±5.8)cm^(2),Valsalva动作下直肠前突者的LH最大面积略大于会阴体过度运动者,二者差异有统计学意义(t=1.63,P<0.10)。结论 盆底四维超声通过测量ARA大小、Valsalva状态LH最大面积量化评估后盆腔异常在诊断女性OOC与其具体分型中有一定的参考价值。

Objective To investigate the value of quantitative evaluation of posterior pelvic abnormalities by measuring the anal right Angle (ARA) and hiatus area of levator ANI (LH) with four-dimensional ultrasound of pelvic floor in the diagnosis of female outlet obstruction constipation (OOC). Methods One hundred and forty-two OOC patients and 68 healthy subjects underwent pelvic floor four-dimensional ultrasound to measure ARA size and maximum LH area in Vasvala state at rest and Vasvala state, and the data of the two groups were compared and analyzed. Results At rest, the ARA size of the research group was (116±10)°, and that of the control group was (107±11)°, the difference was statistically significant (P<0.05). The ARA size of the research group was (107±10)° during Valsalva action, which was smaller than that in the resting state. The ARA size of the control group was (119±11)°, which was higher than that of the resting state, and the difference was statistically significant (P<0.05). The maximum LH area in the research group was (31.5±6.1)cm^(2) and that in the control group was (20.0±2.4)cm^(2), which was larger in the reach group than in the control group (P<0.05). In the OOC component type, the ARA size of the rectoprotrusion patients in resting state was (116±10)°, and that of perineum hypermobility patients was (116±10)°, with no significant difference (P>0.05). The ARA size was (105± 11)° in patients with rectal protuberance under Valsalva movement, which was lower than that in the resting state. The ARA size was (108±9)° in patients with perineal hyperactivity, which was lower than that in resting state. The ARA of patients with rectal prolapse under Valsalva movement was slightly less than that of patients with perineal over movement, and the difference was statistically significant (P<0.10). The largest area of LH under Valsalva action is (32.4±6.2)cm2, and the largest area of LH under Valsalva action is (30.7±5.8)cm2. The largest area of LH under the Valsalva action is slightly larger than the largest area of LH under the Valsalva action, with a statistical difference (P<0.10). Conclusion Quantitative evaluation of pelvic abnormalities by measuring ARA size and maximum area of LH in Valsalva state by four-dimensional pelvic floor ultrasound has a certain role in the diagnosis of female OOC and its specific classification.