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。     

直肠内脱垂底形态研究及临床意义

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例对照才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。     

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。     

排粪造影对功能性肛门直肠梗阻的诊断价值及临床应用(附156例分析)

目的：分析功能性肛门直肠梗阻的病因及X线表现。方法：156例女性患者接受了检查。采用浓度为180％。200％硫酸钡行常规排粪性造影，透视下动态观察并连续摄片。结果：156例患者中，直肠前突96例。会阴下降107例。直肠内套叠59例，盆底痉挛综合征45例，盆底疝7例，内括约肌失弛缓症3例。正常3例，直肠前突常合并会阴下降、直肠内套叠及盆底痉挛综合症。本组病例中，46例直肠前突、29例直肠内套叠、2例内括约肌失弛缓症经临床手术治疗。均获得了良好的效果。结论：排粪性造影较传统的肛直肠部检查更敏感可靠。它能直接显示功能性出口梗阻的原因及发病程度。为临床治疗提供了可靠依据。     

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。     

多层螺旋CT排便造影技术的初步临床应用

目的:探讨多层螺旋CT排便造影技术在盆底疾病检查方面的临床应用价值。方法:对本院48例功能性出口梗阻性便秘的患者进行仰卧位盆腔CT扫描及坐位螺旋CT排便造影检查,男12例,女36例,年龄32~83岁,患者直肠内注入200ml凡士林,在静坐、缩肛及排便3种状态下对盆腔进行冠状位扫描,采用多平面重建(MPR)对扫描图像进行后处理并测量数据。结果:48例患者中发现直肠前突31例、直肠内套叠3例、直肠前壁黏膜脱垂14例、直肠外脱垂1例、盆底痉挛综合征9例、会阴下降34例、内脏下垂4例、肠疝3例,子宫后倾2例、耻骨直肠肌综合征1例。结论:螺旋CT排便造影能准确显示直肠、肛管、盆底肌肉等盆底结构的器质性和功能性异常,是一种简单、无创、实用的检查方法。     

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。     

排粪造影检查在诊断功能性出口梗阻型便秘中的价值

对53例临床初步诊断便秘患者进行排粪造影检查。检查前均行结肠运输试验除外结肠型便秘。结果：直肠前突35例，直肠粘膜内套叠44例，会阴下降24例，盆底肌肉痉挛综合症14例，仅1例未见异常。粪造影检查诊断的敏感性为98．1％，由此表明，应用排粪造影检查诊断功能性出口梗阻型便秘具有极高的敏感性和应用价值。     

直肠脱垂合并小肠疝的排粪造影及静态MRI征象初步分析

目的:分析直肠脱垂合并小肠疝的排粪造影及静态MRI征象,总结其影像特点,为临床治疗提供诊断依据。方法:收集10例直肠脱垂并小肠疝的临床资料,以及其排粪造影及静态MRI检查图像,对其影像征象进行初步统计分析。结果:10例排粪造影力排相均为直肠外脱垂,脱垂长度1~13.3 cm,平均(6.2±3.7)cm,小肠疝低于耻尾线0.8~14.9 cm,平均(8.8±5.2)cm。其中8例行静态MRI检查,均见直肠管腔增宽、壁增厚,部分见直肠黏膜脱垂进入肛管、甚至脱出于肛门外。测量肛提肌裂隙前后径明显增大,横径略增大;双侧髂尾角增大,左侧平均(62.5±6.70)°,右侧平均(67.1±8.0)°。结论:排粪造影对直肠脱垂合并小肠疝有较高的影像诊断价值,可动态观察、客观评估直肠脱垂分型、程度及合并小肠疝的程度,结合静态MRI可更全面地评估盆底软组织及骨性结构,特别是直肠情况,为临床下一步治疗提供依据。     

直肠排粪造影在便秘患者病因诊断中的意义

目的评价直肠排粪造影在便秘原因诊断中的意义。方法56例临床怀疑由于肛肠疾病引起的便秘患者（女51例,男5例,年龄33～72岁,平均41岁）均在经肛门——直肠灌注对比剂为160％（W／V）的硫酸钡250mL后接受了直肠排粪造影。结果在56例便秘患者中,直肠前突见于42例。耻骨直肠肌肥厚4例,直肠前壁黏膜脱垂3例,直肠内套叠3例,乙状结肠疝2例,直肠息肉1例,以及经病理证实的直肠癌1例。结论直肠排粪造粪造影在便秘的病因学诊断中具有高度准确性。     

Proposal for a radiologic classification of disorders of the pelvi-rectal angle based on measurement of the posterior rectal inclination. Value of dynamic digitalized rectography

The difficulties for evaluation of the perineal descent have always been linked to the choice of references and mostly with the incertitude of the measurement of length on the radiographic film. This present study was carried out to evaluate the perineal descent on the choice of an angular measurement: the posterior rectal inclination. The dynamic digitalized rectography was used to investigate the pelvic floor status of 134 women: 115 patients complaining of idiopathic constipation, and 19 healthy volunteers. Results have shown 3 populations with an increasing graduation of perineal impairment and led to propose a radiologic classification of pelvic floor impairment: stage I, or solid perineum, stage II, or descending perineum and stage III or descended perineum. This study has brought up that the first sign of a pelvic floor abnormality may be increased descent during straining, only later followed by perineal descent at rest. The relationship linking abnormal perineal descent and excessive opening of the ano-rectal angle suggested logically that fecal incontinence may be the end complication of the Descending Perineum Syndrom.     

Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography

A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.     

盆底功能性疾病的动态MRI研究

目的　评价盆底动态MRI形态学表现与盆底功能性疾病的相关性。资料与方法　采用Siemens 1.0T超导磁共振成像仪对 6 0例妇女进行MRI检查 ,将这些受试者分为两组 :30例为无症状健康志愿者和 30例为盆底功能性疾病患者。采用仰卧位使用梯度回波二维FLASHT1WI快速扫描序列获得屏气期间盆底横断面、冠状面和矢状面的静息和最大盆腔用力时MR影像。所有影像用于观测盆腔器官脱垂和盆底形态 ,比较两组间盆腔器官脱垂和盆底形态变化的程度。结果　盆腔器官脱垂常发生于多个部位 ,盆底功能性疾病患者发生频率较高 ,与健康受试者比较相差显著 :膀胱膨出 (P <0 .0 1) ,子宫颈脱垂 (P <0 .0 1) ,盆底疝 (P <0 .0 1) ,直肠连接异常下降 (P <0 .0 1) ,直肠膨出 (P <0 .0 1)和盆隔裂孔膨胀 (P <0 .0 1)。结论　盆底动态MRI可用于准确评价盆腔器官脱垂和盆底形态 ,盆底功能性疾病患者常出现整个盆底软弱 ,盆腔器官脱垂频繁发生于多个部位并伴随盆隔裂孔的显著膨胀     

Dynamic MR imaging of the pelvic floor in asymptomatic subjects

OBJECTIVE: Dynamic MR imaging may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse and configuration. MR criteria for normality are derived from proctographic studies because no large MR study of asymptomatic individuals has been performed. Our study aimed to define the normal range of dynamic pelvic MR appearances in a large group of asymptomatic individuals. SUBJECTS AND METHODS: Fifty healthy adult volunteers (25 men and 25 women; age range, 20-66 years; mean age, 34 years) were prospectively recruited and examined using dynamic MR imaging. All subjects were interviewed and established as healthy using a validated questionnaire. Axial, coronal, and sagittal MR imaging was performed at rest and during maximum pelvic strain using a static 1.0-T unit and a fast-field-echo sequence, providing 10 slices in 31 sec. Standardized measurements of pelvic configuration were taken, and rest and strain imaging were compared to determine the range of normal appearances. RESULTS: Three women developed a cystocele during maximum pelvic strain, two of whom also showed grade 1 uterocervical prolapse, which was also seen in another woman. Three men showed posterior pelvic floor descent in excess of 3 cm during straining. No rectocele, enterocele, rectal prolapse, or perineal hernia was seen in any subject. CONCLUSION: The normal range of pelvic organ descent in asymptomatic subjects seen on dynamic MR imaging included cystocele, uterocervical prolapse, and excessive anorectal junction descent. Although we encountered pelvic prolapse in seven volunteers, it was infrequent and low grade, suggesting that criteria for abnormality derived from proctography are generally applicable to MR imaging.     

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.     

排便造影动态观察盆底形态对功能性出口梗阻所致便秘的诊断价值

目的探讨仅在排便过程中才表现出来的直肠、肛管的一系列功能性异常. 资料与方法通过钡灌肠,于坐位进行排便,动态下透视、点片. 结果 520例中,发现直肠黏膜脱垂、套叠416例,直肠前突281例,盆底及会阴下降229例,盆底肌失弛缓综合征170例,盆底疝113例,骶直分离等其他盆底病变43例.合并上述两项以上病变者多见. 结论排便造影动态观察盆底形态是较传统的钡灌肠、临床指诊、内镜检查更为敏感可靠的方法,能为临床诊治功能性出口梗阻所致便秘等肛肠疾病及选择手术治疗提供可靠的依据.     

Defecography by spiral computed tomography

PURPOSE: We investigated the possible role of helical CT defecography in pelvic floor disorders by comparing our results with those of conventional defecography. MATERIAL AND METHODS: Our series consisted of 90 patients, namely 62 women and 28 men, ranging in age 24-82 years. They were all submitted to conventional defecography, and 18 questionable cases were also studied with helical CT defecography. The conventional examination was performed during the 4 standard phases of resting, squeezing, Valsalva and straining; we used a remote-control unit. The parameters for helical CT defecography were: 5 mm beam collimation, pitch 2, 120 KV, 250 mAs and 18-20 degrees gantry inclination to acquire coronal images of the pelvic floor. The rectal ampulla was distended with a bolus of 300 mL nonionic iodinated contrast agent (dilution: 3 g/cc). The patient wore a napkin and was seated on the table, except for those who could not hold the position and were thus examined supine. Twenty-second helical scans were performed at rest and during evacuation; multiplanar reconstructions were obtained especially on the sagittal plane for comparison with conventional defecographic images. RESULTS: An unquestionable diagnosis could be made in all the 18 patients submitted to helical CT defecography. The diagnosis was in agreement with proctology results and added new information in all cases. Sixteen patients had constipation and 2 fecal incontinence--one from rectal prolapse and the other from a rectovaginal fistula. In this latter case helical CT defecography permitted to confirm the fistula and suggest its course. One patient had a previously undetected ovarian cancer metastatic to the anterior rectal wall. DISCUSSION AND CONCLUSIONS: Coronal helical CT defecography images permitted to map the perineal floor muscles, while sagittal reconstructions provided information on the ampulla and the levator ani. To conclude, helical CT defecography performed well in the study of pelvic floor disorders and can follow conventional defecography especially in questionable cases.     

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。