MRI联合排粪造影检查在肛提肌板及肛直角变化所致老年便秘中应用研究

MRI combined with defecography on senile constipation caused by changes of levator plate and anal right Angle

目的 采用MRI联合排粪造影检查分析肛提肌板及肛直角变化所致老年便秘的影像学机制。方法 选取2019年9月至2022年9月山东第一医科大学第一附属医院收治的30例老年性便秘病人为观察组,同期招募30名老年健康志愿者为对照组。两组均在静息、力排期行盆底MRI及排粪造影检查,测量肛提肌板下降幅度(△M-Line)及肛直角角度变化(△ARA°)。结果 (1)观察组和对照组在静息状态下M线的长度(M-Line)、肛直角角度(ARA°)分别为[(9.79±1.78)mm vs.(9.65±1.29)mm,P=0.741]、[(92.76±3.34)°vs.(93.91±5.48)°,P=0.335],两者比较,差异均无统计学意义(P>0.05);观察组和对照组在力排状态下M-Line、ARA°分别为[(14.81±1.74)mm vs.(13.79±1.42)mm,P=0.016]、[(103.07±4.84)°vs.(106.12±4.89)°,P=0.019],两者比较,差异有统计学意义(P<0.05);观察组和对照组在两种状态下△M-Line、△ARA°分别是[(5.02±1.76)mm vs.(4.14±1.26)mm,P=0.029]、[(10.31±3.36)°vs.(12.21±2.91)°,P=0.021],两者比较,差异有统计学意义(P<0.05)。(2)观察组在两种状态下肛提肌板下降幅度与Wexner便秘量化评分存在正相关(相关系数R=0.852,P<0.05);肛直角角度变化(△ARA°)与病人Wexner便秘量化评分存在负相关(相关系数R=-0.813,P<0.05)。结论 MRI联合排粪造影可动静态观察老年性便秘病人肛提肌板下降幅度及肛直角角度变化,为临床精准化诊治老年性便秘提供新的依据。

Objective To analyze the imaging mechanism of senile constipation caused by the changes of levator ani muscle plate and anus right angle by MRI combined with defecography.Methods 30 elderly constipation patients admitted to The First Affiliated Hospital Of Shandong First Medical University from September 2019 to September 2022 were selected as the observation group,and 30 elderly healthy volunteers were recruited as the control group at the same time.In both groups,pelvic floor MRI and defecography were performed at rest and during forced ovulation to measure the decline of levator ani muscle plate(△M-Line)and the change of anal right angle(△ARA).Results(1)The length of M-Line and the angle of right angle of anus(ARA)in the observation group and the control group at rest were[(9.79±1.78)mm vs.(9.65±1.29)mm,P=0.741]and[(92.76±3.34)°vs.(93.91±5.48)°,P=0.335],respectively.There was no significant difference between the two groups(P>0.05);the M-Line and ARA°of the observation group and the control group were[(14.81±1.74)mm vs.(13.79±1.42)mm,P=0.016]and[(103.07±4.84)°vs.(106.12±4.89)°,P=0.019]respectively under the force displacement state,with significant difference(P<0.05);△M-Line and△ARA°were[(5.02±1.76)mm vs.(4.14±1.26)mm,P=0.029]and[(10.31±3.36)°vs.(12.21±2.91)°,P=0.021].There was significant difference between the two groups(P>0.05);(2)There was a positive correlation between the decline of levator ani muscle plate and Wexner's constipation quantitative score in the observation group under two conditions(correlation coefficient r=0.852,P<0.05);there was a negative correlation between the change of anal right angle(△ARA°)and Wexner's constipation quantitative score(correlation coefficient r=-0.813,P<0.05).Conclusion MRI combined with defectography can dynamically and static observe the decline of levator ANI muscle plate and the change of anal Angle in patients with senile constipation,so as to provide a new basis for clinical accurate diagnosis and treatment of senile constipation.