动态MRI联合排粪造影在出口梗阻型便秘诊治中的应用

目的 采用盆底动态MRI联合排粪造影技术研究出口梗阻型便秘患者盆底功能失调情况,评价其对诊断出口梗阻型便秘的敏感性、可行性.方法 选取2007年7月至2009年3月收治的109例临床表现有排便频率改变和排便困难、盆部坠胀痛等的盆底功能失调的女性患者.对患者进行盆底MRI和排粪造影检查,评价盆底解剖结构.结果 盆底动态MRI共诊断膀胱膨出54例(49.6%)、直肠子宫陷窝疝11例(10.1%),会阴脱垂29例(26.6%)、直肠前膨出71例(65.2%),外括约肌萎缩19例(18.2%)、耻骨直肠肌痉挛综合征32例(29.4%).排粪造影检查结果发现直肠前膨出和耻骨直肠肌痉挛综合征的诊断符合率为100%.但排粪造影检出骶直分离征33例(30.3%)、直肠黏膜脱垂和(或)套叠41例(37.7%),盆底动态MRI未能显示直肠黏膜的脱垂和套叠.结论 盆底动态MRI能够较全面的评价盆底功能性疾病,具有较好的灵敏度,其不足可通过排粪造影来弥补.

Application of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome

Objective To evaluate the sensitivity and feasibility of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome. Methods One hundred and nine female with pelvic floor disorders, such as difficult defecation, fecal incontinence or urinary incontinence, pelvic pain, were treated from July 2007 to March 2009. Pelvic floor dynamic MRI and defecography with homemade high conformable sacculus was performed in the patients to evaluate pelvic floor anatomy. Results Fifty-four cases (49. 6% ) of cystocele and 11 cases( 10. 1%) of rectouterine pouch hernia, 29 cases (26. 6%) of perineum prolapse and 71 cases (65. 2% ) of rectocele were found by dynamic MRI. The dynamic MRI also revealed 19 cases (18. 2% ) of external sphincter trophy and 32 cases ( 29.4%) of spastic pelvic floor syndrome. Compared with defecography, dynamic MRI was more positive in diagnosing enterocele. Defecography Of the patients, sacrum-rectal separate was found in 33 cases (30. 3% ) and rectal mucosal prolapse or internal rectal intussusceptions in 41 cases (37. 7% ) by defecography, while dynamic MRI found none. Conclusions As a new noninvasive imaging technique to evaluate the pelvic floor function, dynamic MRI is more sensitive, especially for patients with complicated multi-organs prolapse, and its deficiency could be remedied by defecography.