动态直肠排粪造影在出口梗阻型便秘中的应用价值(附1055例分析)

目的分析出口梗阻型便秘的主要病因及其直肠排粪造影表现,探讨动态直肠排粪造影对出口梗阻型便秘的价值。方法 1174例便秘患者行直肠排粪造影检查,透视下动态观察并摄片;其中阳性1055例(男性170例,女性885例)。结果出口梗阻型便秘男性患者的主要病因为盆底痉挛综合征,而女性患者的主要病因为直肠前突、直肠粘膜脱垂。出口梗阻型便秘患者常多种病因共存。结论动态直肠排粪造影能显示出口梗阻型便秘的直接原因,为出口梗阻型便秘的诊疗提供可靠依据。     

动态MR排粪造影在女性出口梗阻型便秘中的应用

目的 探讨动态MR排粪造影(DMRD)在女性出口梗阻型便秘的应用价值,并尝试对2种MR动态序列进行对比,优化检查方法.方法 回顾性分析26例临床确诊为出口梗阻型便秘女性患者的DMRD资料,年龄40~73岁,平均58岁,患者取仰卧位,将含钆喷酸葡胺注射液的玉米糊约200 mL注入直肠,应用T1W快速梯度回波(T1-TFE)和平衡式稳态自由进动(B-TFE)序列,采集患者静息、提肛及排便时盆底结构的矢状位图像,测量盆底的相关数据.结果 ①26例患者DMRD均发现盆底结构功能异常,与临床最终诊断结果完全符合者20例(20/26).DMRD诊断直肠膨出2例(2/26),耻骨直肠肌肥厚1例(1/26),联合性病变23例(23/26),包括直肠膨出、会阴下降、膀胱脱垂、子宫颈脱垂、盆底痉挛、耻骨直肠肌肥厚、直肠黏膜脱垂以不同组合方式出现.②T1-TFE和B-TFE 2种检查序列诊断结果一致,前者图像信噪比优于后者.结论 DMRD 2种序列均能准确评价女性出口梗阻型便秘患者的盆底形态及功能性病变,前者图像质量更佳.     

磁共振排粪造影在出口梗阻型便秘中的应用价值

目的 探讨MR排粪造影在出口梗阻型便秘的诊断及治疗方式的选择方面的价值.方法 回顾性分析56例经临床检查拟诊出口梗阻型便秘行MR排粪造影检查患者的图像资料,以其最终出院诊断为标准,对照分析患者的临床检查结果及MR表现,以评价MR排粪造影的诊断价值;同时评价其对患者治疗方式选择的影响.统计学分析采用χ2检验.结果 在42例女性患者中,MR排粪造影对直肠下降、膀胱膨出及耻骨直肠肌痉挛的诊断价值明显优于临床检查;对直肠前突及子宫膨出的诊断,两者无明显差别;对直肠套叠的诊断,临床检查明显优于MR排粪造影.发现40例患者有盆底下降,其中中、重度下降32例,累及2盆及以上者占20例;在14例男性患者中,8例表现为耻骨直肠肌痉挛,其中4例伴轻度盆底下降.在全部(56例)患者中,MR检查与临床检查基本一致者有26例.28例患者的MR检查相对于临床检查有新发现,其中19例的治疗方式因此改变.结论 MR排粪造影以其多方面的优势,在出口梗阻型便秘患者(尤其是女性患者)的诊断以及治疗方式的选择上均具有重要的价值.     

便秘的病因与排粪造影诊断价值的探讨

目的：分析便秘的原因并评价排粪造影对出口梗阻型便秘的诊断价值。方法：对１００例便秘患者作排粪造影分析。结果：出口梗阻者９６例,其中单纯性直肠前突１９例（１９．７９％）,直肠前突伴有其他异常４０例（４１．６７％）,直肠粘膜脱垂及其合并症３７例（３８．５４％）。结论：由于出口梗阻结肠无力常合并存在并相互作用导致便秘的发生。作者强调排粪造影能对出口梗阻做出准确的病因学诊断。排粪造影的正确应用为肛肠外科医     

出口梗阻型便秘的外科治疗

目的　探讨出口梗阻型便秘 (outlet obstruction constipation,OOC)的诊断方法、手术指征及术式选择。方法　本组65例均经肛门指诊、排粪造影和结肠传输试验检查 ,术前获得诊断 :直肠前膨出 40例 ,直肠粘膜内脱垂或内套叠 42例 ,肛门内括约肌失弛缓症 2 3例 ,耻骨直肠肌肥厚 2 1例 ,盆底痉挛综合征 9例 ,盆底下降 9例 ,骶直分离 1 3例 ;根据检查结果分别采用 :直肠前膨出修补术、直肠粘膜固定术、直肠粘膜部分切除加固定术、肛门内括约肌部分切除术、耻骨直肠肌部分全切、耻骨直肠肌部分全切加闭孔内肌自体移植术。结果　治愈 5 9例 (90 .8% ) ,好转 4例 (6.1 % ) ,无效 2例 (3 .1 % )。结论　对出口梗阻型便秘患者必须进行肛门指诊、排粪造影和结肠传输试验三项基本检查 ,根据这三项检查一般都能明确诊断。手术疗效确切 ,但术式选择应根据三项具体检查结果而定     

排粪造影X线测量在功能性便秘诊断中的应用价值

目的探讨排粪造影X线测量在功能性便秘病因诊断中的应用价值。方法对35例出现临床症状的功能性便秘患者,进行排粪造影检查,显示直肠病变程度和并发症情况,进行图像采集和后处理,分别测量肛直角(ARA)、肛上距(DUAC)、直肠前突深度、乙耻距(DSPC)、骶直距(DSR)。结果 X线良好的显示了全部直肠功能性病变,本组35例患者中,直肠前突26例,直肠前壁黏膜脱垂18例,直肠内套叠3例,耻骨直肠肌肥厚2例,乙状结肠冗长1例。结论排粪造影X线测量在功能性便秘的病因诊断中具有较高的应用价值。     

排粪造影51例临床应用研究

目的 研究排粪造影对便秘的诊断价值。方法 对51例便秘患行排粪造影检查。结果 直肠前凸32例，盆底痉挛综合征13例，耻骨直肠肌综合征3例，会阴下降35例，直肠粘膜脱垂2例，直肠内套叠2例，直肠外脱垂1例．内脏下垂9例，肠疝1例，骶直分离9例，未见异常2例。结论 排粪造影检查对功能性出口梗阻病变的诊断价值明显优于传统的钡灌肠和内窥镜等检查。     

直肠内注入模拟粪便的动态MRI对女性盆底痉挛综合征的诊断价值

目的 利用动态MRI研究直肠内模拟粪便注入前、后女性盆底痉挛综合征(SPFS)患者的肛直肠形态、功能性病变, 并对多盆腔器官脱垂进行评价, 明确注入球囊后的动态MRI在SPFS患者中的诊断优势。 方法 对53例临床诊断为SPFS的女性患者行动态MRI检查, 使用自行设计高顺应性球囊模拟大便, 测量患者直肠内球囊注入前、后力排相盆底的相关数据。 结果 盆底动态MRI结果显示, 53例女性SPFS患者中, 伴发多盆腔器官脱垂者24例。直肠内造影剂注入前、后力排相的肛直角变化, 差异无统计学意义(χ2=0.603, P > 0.05);相比直肠内模拟粪便注入后的盆底动态MRI, 未注入的力排相分别有18.0%(9/50)膀胱脱垂、6.1%(3/49)子宫或阴道穹窿脱垂、32.7%(17/52)直肠前膨出及14.6%(7/48)会阴体下降诊断为阴性。直肠内模拟粪便注入前、后力排相观察多盆腔器官脱垂变化, 差异均有明显统计学意义。 结论 直肠内注入模拟粪便的盆底动态MRI为女性SPFS患者提供了更全面的诊断, 为术前正确诊断盆腔多部位缺陷及术后正确评价治疗效果提供了客观依据。     

直肠内脱垂盆底形态研究及临床意义

目的：建立一种在手术前能区别直肠内脱垂中粘膜脱垂和全层套叠的影像学方法。材料和方法：６６例直肠内脱垂和３６例对照者均行排粪造影结合盆腔造影，测量肛直角、会阴位置等指标并结合手术中所见的盆腔变化。结果：４１例患者在排粪中无盆底腹膜变化为直肠粘膜脱垂；２５例盆底腹膜随直肠前壁下降为直肠全层套叠，伴直肠鞘部腹膜构成疝囊的直肠壁内疝。结论：本造影方法可准确区别直肠粘膜脱垂和全层套叠，并显示直肠壁内疝的疝囊，为临床治疗直肠内脱垂提供了可靠的依据。     

排粪造影结合盆腔造影诊断直肠内脱垂

目的：设计一种盆腔造影结合排粪造影的方法，以期区分直肠粘膜脱垂与直肠全层套叠，指导直肠内脱垂的治疗。材料与方法：８２例直肠内脱垂和３６例对照者行排粪造影结合盆腔造影。结果：在８２例患者中，５０例有直肠内脱垂征象、而盆底腹膜正常者为直肠粘膜脱垂，其中２６例伴异常会阴下降；３２例有直肠内脱垂征象、盆底腹膜随直肠前壁降入套叠鞘部、并构成直肠壁内疝疝囊者为直肠全层套叠，６例疝囊上口敞开者术中证实有内容物疝入，２０例伴异常会阴下降。结论：排粪造影结合盆腔造影是区分粘膜脱垂与全层套叠、诊断直肠内脱垂伴发的直肠壁内疝等盆底疝等直观、可靠的方法。     

Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease.

Functional disorders of the pelvic floor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspecific symptoms such as constipation or incontinence, remain difficult. Fluoroscopic x-ray defecography has been shown to aid in detection of functional and morphologic abnormalities of the anorectal region. With the advent of open-configuration magnetic resonance (MR) imaging systems, MR defecography with the patient in a vertical position became possible. MR defecography permits analysis of the anorectal angle, the opening of the anal canal, the function of the puborectal muscle, and the descent of the pelvic floor during defecation. Good demonstration of the rectal wall permits visualization of intussusceptions and rectoceles. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic floor syndrome and descending perineum syndrome and visualization of enteroceles. MR defecography with an open-configuration magnet allows accurate assessment of anorectal morphology and function in relation to surrounding structures without exposing the patient to harmful ionizing radiation.     

功能性便秘的病因与影像学诊断

目的：分析便秘的病因并评价结肠运输试验与排粪造影对诊断便秘的价值。方法：对１００例便秘患者作结肠运输试验及排粪造影。结果：结肠运输异常者４３例,出口梗阻者９６例,两种均存在者占４２例。４２例中,外科单纯纠正出口梗阻３１例,术后随访发现１５例症状无明显改善且复查排粪造影均表现正常。结论：由于出口梗阻与结肠无力常合并存在并相互作用,作者强调：结肠运输试验与排粪造影联合应用将有助于作出正确、全面的诊断和制定恰当的治疗方案。     

MR排便造影在后盆腔障碍性疾病中的评估价值

后盆腔障碍疾病是以肛直肠解剖和功能异常为主的一类盆底功能障碍性疾病,伴有便秘、便失禁等临床症状。MR排便造影是一种动态MR成像方法,可对后盆腔结构形态和运动功能异常情况直观显示,能够鉴别后盆腔障碍性疾病的类型并认识其发病原因,如直肠膨出、肠疝、盆腔器官脱垂和直肠套叠、脱垂等,同时对便失禁早期的肛直肠形态学和功能学异常改变的诊断有重要提示价值。     

结肠运输实验与排粪造影在诊断便秘中的临床应用(附110例分析)

目的　分析便秘的原因 ,并评价结肠运输实验与排粪造影对诊断便秘的价值。方法　对 110例临床诊断为便秘患者先做结肠运输实验 ,再做排粪造影。结果　结肠运输实验异常者 79例 ;排粪造影异常者 5 3例。综合分析结肠运输实验与排粪造影 ,诊断为结肠慢运输 40例 ,功能性出口梗阻 5 3例。结论　结肠运输实验与排粪造影联合应用 ,能够更加准确区分结肠慢运输与功能性出口梗阻所致的便秘 ,进一步明确功能性出口梗阻的病因 ,为临床治疗提供可靠的依据。     

排粪造影对功能性出口梗阻便秘的诊断

目的　探讨排粪造影对功能性出口便秘的诊断价值。方法　对 5 0 0例功能性出口便秘患者进行排粪造影检查。女性 3 49例 ,男性 15 1例 ,年龄 14～ 78岁 ,平均 3 6.7岁。病史在 2个月～ 3 8年。主要临床症状 :排便困难、不适、腹痛、腹胀 ,排便时间延长 ,肛门坠胀及解不净 ,多数病人需长期服泻药及灌肠帮助排便。排粪造影是给病人灌入 40 0～ 60 0ml硫酸钡混悬液 ,病人侧坐在排便装置上 ,在X线电视下作动态观察、摄片。结果　通过对 5 0 0例患者排粪造影检查 ,发现有直肠前突 14 4例、直肠黏膜脱垂 75例、直肠内套叠 5 6例、盆底痉挛综合征 10 2例、耻骨直肠肌肥厚 65例、会阴下降 12 1例、正常 2 9例 ,以上症状多数由两种或两种以上同时出现。结论　排粪造影对功能性出口便秘的诊断具有重要价值。     

排粪X线造影在肠易激综合征诊断中的应用

为了解排粪X线造影在肠易激综合征患者中的应用价值，对12例便秘为主型、10例便秘和腹泻交替型、14例腹泻型肠易激综合征患者进行排粪X线造影。结果排粪造影阳性的例数为13例（36.11％），排便过程中的异常有多种，包括直肠前突、直肠粘膜脱垂、内脏下垂、会阴下降和盆底痉挛综合征等。说明排粪X线造影对肠易激综合征的诊断和治疗有一定的价值。     

排粪造影在功能性出口梗阻诊断中的临床意义

目的探讨排粪造影在诊断与治疗功能性出口梗阻性便秘中的应用。方法对186例排便障碍者进行排粪造影检查与治疗。结果 7例X线无异常,179例有异常X线表现。其中直肠前突113例,直肠黏膜脱垂、内套叠92例,会阴下降64例,盆底痉挛综合征11例,耻骨直肠肌综合征7例,内脏下垂7例,乙状结肠疝3例。其中多种异常表现并存69例。结论排粪造影对功能性出口梗阻性便秘的诊断与治疗具有重要价值。     

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

Objectives

We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation.

Methods

48 patients (34 females, 14 males; mean age 48 years) with constipation and clinically suspected dyssynergic defecation underwent MR defecography. Patients were divided into patients with dyssynergic defecation (n = 18) and constipated patients without dyssynergic defecation (control group, n = 30). MRIs were analysed for evacuation ability, time to initiate evacuation, time of evacuation, changes in the anorectal angle (ARA-change), presence of paradoxical sphincter contraction and presence of additional pelvic floor abnormalities. Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of dyssynergic defecation were calculated.

Results

The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic defecation of 100% (95% confidence interval (CI) 97–100%), but a specificity of only 23% (95% CI 7–40%). A lower sensitivity (50%; 95% CI 24–76%) and a high specificity (97%; 95% CI 89–100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63–100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81–100%) of the patients with dyssynergic defecation.

Conclusion

MR defecography detects functional and structural abnormal findings in patients with clinically suspected dyssynergic defecation. Impaired evacuation is seen in patients with functional constipation owing to other pelvic floor abnormalities than dyssynergic defecation.Dyssynergic defecation, which produces functional outlet obstruction during defecation, is one of the causes of chronic constipation. Dyssynergic defecation is a functional disorder characterised by either paradoxical contraction, an inability to relax the anal sphincter and/or puborectalis muscle, or impaired abdominal and rectal pushing forces. In the literature, many other terms such as anismus [1], dyskinetic puborectalis muscle [2], non-relaxing puborectalis syndrome [3], spastic pelvic floor syndrome [4, 5] and pelvic floor dyssynergia [6] have been used. An expert group (Rome III) [7] recently proposed the term “dyssynergic defecation” to appropriately describe the failure of co-ordination or dyssynergia of the abdominal and pelvic floor muscles involved in defecation. Different physiological tests can be used to investigate this functional disorder, including the balloon expulsion test, electromyography (EMG) of the puborectalis muscle and anorectal manometry. Defecography can be performed to rule out structural rectal abnormalities and provide an estimate of the degree of rectal emptying. As false-positive and false-negative results are common with these different tests, none can be used by itself as a gold standard for identifying patients with dyssynergic defecation.Most authorities recommend using a combination of diagnostic tests and clinical history. The Rome III expert group defined the criteria for the diagnosis of dyssynergic defecation based on clinical history, anorectal manometry, balloon expulsion test, EMG and conventional defecography (evacuation proctography) [7]. Functional imaging with conventional defecography is considered to be a useful adjunct in establishing the diagnosis of dyssynergic defecation. Delayed initiation of evacuation and impaired evacuation in particular, as seen on conventional defecography, are highly predicitive for the presence of dyssynergic defecation [8, 9]. Different structural imaging findings in conventional defecography have been described in patients with dyssynergic defecation; however, the usefulness of these findings is discussed controversially [8, 10, 11].The experience with MR defecography, which has shown to be a valuable alternative to evacuation proctography [12–15], is limited in dyssynergic defecation patients. There is only one study which has focused on the MR defecography findings in a study setting in patients with dyssynergic defecation [16]. Hence, the purpose of this study was to describe the spectrum of findings in MR defecography in patients referred with the suspicion of dyssynergic defecation and to assess the value of MR defecography in establishing this diagnosis. For the latter, the patients with dyssynergic defecation were compared with a group of constipated patients without dyssynergic defecation.