排粪造影的临床应用

介绍排粪造影方法，报告１６０例造影结果。对照组５２例中２例（３８５％）异常；排粪障碍组１０８例，仅１８例（１６６７％）未见异常，提出了肛直角和肛上距正常测量值。报道主要异常Ｘ线表现。探讨了排粪造影检查对于肛管直肠部及盆底疾病的诊断价值     

Fecal incontinence successfully managed by antegrade continence enema in children: A report of two cases

Two children with intractable fecal incontinence after correction of high anorectal malformations were successfully managed by the daily administration of a glycerin enema into the cecum via an appendicocecostomy or tubularized cecostomy, according to the method of Malone's antegrade continence enema (ACE). Fluoroscopic defecography performed during this procedure in each patient disclosed that the glycerin enema promptly evoked cecal peristalsis, which was transmitted to the distal colon and rectum, and squeezed out almost all the fecal matter, evacuating it from the anus. However, two enemas within a short interval were required to achieve a complete washout of feces. Although this report describes only two patients, our experience confirmed that the ACE was very effective and that adding the word continence to antegrade enema was justifiable. Moreover, fluoroscopic defecography was proven to play a significant role in determining the appropriate regimens of this technique to achieve complete washout of the feces.     

聚乙二醇4000治疗出口梗阻型便秘的临床疗效观察

目的　评价聚乙二醇 4 0 0 0 (PEG 4 0 0 0 )治疗出口梗阻型便秘 (OOC)的临床疗效。方法　采用随机对照试验方法 ,选择OOC 6 9例 ,随机分为治疗组 (36例 )和对照组 (33例 ) ,分别接受PEG 4 0 0 0和乳果糖治疗 ,疗程 4周并评估其疗效。总体疗效评估采用模拟视觉梯度的评分方法 (1 0 0mmVAS)。结果　治疗 2周和 4周后 ,二组每周排便次数较治疗前均显著增加 ,大便性状、排便困难和直肠排空感均也比治疗前明显改善 (P <0 .0 1 ) ,但二组间差异无显著性 (P <0 .0 5 ) ,其中大便性状改善PEG 4 0 0 0明显优于乳果糖 (P <0 .0 5 )。大便性状恢复正常比例治疗组大于对照组 (治疗 2周和 4周后 ,分别为 75 .0 %和 83.3%比 5 1 .5 %和 6 0 .6 % ,P <0 .0 5 )。PEG 4 0 0 0组 1 0 0mmVAS评分为75 .3,显著高于乳果糖组的 5 4 .8(P <0 .0 5 )。结论　聚乙二醇 4 0 0 0治疗出口梗阻型便秘安全有效     

α-受体阻滞剂联合Cox-2抑制剂对Ⅲb型前列腺炎患者的疗效观察

目的 观察α-受体阻滞剂联合Cox-2抑制剂对Ⅲb型前列腺炎(CPⅢb)的临床疗效,并结合其作用原理探讨CPⅢb的发病机制.方法 从2012年9月至2013年9月期间在我院门诊就医的CPⅢb患者中,经排粪造影检查筛选合并耻骨直肠肌痉挛并完成随访的患者40例,分为单用α-受体阻断剂盐酸坦索罗辛(A组)和盐酸坦索罗辛联合Cox-2抑制剂塞来昔布组(B组),分别予以药物治疗,对治疗前及治疗2、4、6周进行IPSS评分,生活质量评分(QoL),依据症状改善评价疗效.结果 耻骨直肠肌痉挛患者排粪造影表现为排便时耻骨直肠肌压迹直肠肠壁形成“鹅征”.对诊断伴有耻骨直肠肌痉挛的Ⅲb型前列腺炎患者,2组治疗效果在各期随访中均有一定程度的改善,患者IPSS尿频、尿急等症状分数明显降低(P＜0.05),治疗评价对比B组患者IPSS评分以及尿频、尿急、尿不尽等分项评分和Qol均比A组改善明显(P＜0.05).结论 联合使用Cox-2抑制剂缓解耻骨直肠肌痉挛可明显提高CPⅢb的治疗效果,提示耻骨直肠肌痉挛与CPⅢb患者下尿路症状的发生有关.     

Symptomatic rectocele: what are the indications for repair?

Background

The surgical indications for symptomatic rectocele are undefined, and surgery has high recurrence rates. We implemented magnetic resonance imaging defecography (MRID) to determine if utilizing strict inclusion criteria for rectocele repair improves outcomes.

Methods

Patients with obstructive defecation syndrome (ODS) who underwent dynamic MRID were evaluated. Indications for surgical repair were defecation requiring manual assistance and the following MRID results: anterior defect >2 cm, incomplete evacuation, and the absence of perineal descent. Primary outcomes were the change in quality of life (QOL) scores and recurrence.

Results

From 2006 to 2013, 143 patients who presented with ODS underwent MRID. Seventeen patients met the criteria for repair. Recurrence was low (5.8%) with a median follow-up of 23 months, QOL scores improved from 57.3 to 76.5 (P = .041).

Conclusions

A minority of patients (12%) with ODS met the above criteria for rectocele repair. Patients who underwent repair had a significant improvement in QOL and low recurrence rate.     

三维肛管直肠腔内超声对耻骨直肠肌综合征的诊断价值

探讨通过三维肛管直肠腔内超声及直肠排粪造影检查评价三维肛管直肠腔内超声对耻骨直肠肌综合征的临床诊断价值。对200例耻骨直肠肌综合征患者进行三维肛管直肠腔内超声与直肠排粪造影检查,对两种检查结果进行回顾性分析。结果表明,肛肠三维肛管直肠腔内超声检查能准确地诊断耻骨直肠肌综合征,为临床提供客观可靠的依据。     

动态经会阴超声对女性排便梗阻综合征诊断价值的研究

目的 以传统X线排粪造影为金标准,评估动态经会阴超声对女性排便梗阻综合征的诊断价值。方法 回顾性分析2019年6月至2021年12月南京中医药大学附属南京中医院收治97例女性排便梗阻综合征患者资料,患者均接受X线排粪造影和动态经会阴超声检查,分别对直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便进行评估,并对两种影像学的诊断结果进行一致性检验。结果 动态经会阴超声诊断直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便的灵敏度分别为88%、86%、83%、67%、95%,特异度分别为90%、96%、99%、96%、86%。两种影像学在评估直肠前突分度上显示一致性中等,Kappa系数为0.538;直肠黏膜内套叠、会阴下降和不协调性排便一致性较好,Kappa系数分别为0.727、0.655、0.791;肠疝一致性极好,Kappa系数为0.822。经会阴超声测得静息状态肛直角大于X线排粪造影(121.79±9.54 vs.112.69±11.73,P <0.05)。结论 动态经会阴超声在诊断女性排便梗阻综合征上显示了较高特异性,是一项有效评估女性排便梗阻综合征的影像学技术。     

耻骨直肠肌部分切除治疗耻骨直肠肌综合征1 49例

目的观察耻骨直肠肌部分切除术的治疗效果.方法149例经直肠排粪造影和耻骨直肠肌肌电图确诊为耻骨直肠肌综合征患者,经尾骨下正中切口行耻骨直肠肌部分切除术,术后观察其临床症状改善情况,复查直肠排粪造影了解其影像学变化.结果手术后排便困难均得到完全缓解,肛门坠胀或疼痛有15例未完全消除,但程度明显减轻;直肠排粪造影显示耻骨直肠肌压迹消失.结论耻骨直肠肌部分切除术治疗耻骨直肠肌综合征方法简便,疗效好,并发症少.     

直肠瓣过宽导致出口梗阻型便秘的临床治疗

目的探讨直肠瓣过宽导致出口梗阻型便秘的的治疗方法。方法回顾分析出口梗阻型便秘30例患者其中并直肠粘膜内脱垂患者10例。经临床行挂线手术资料。结果治愈率达90％，有效率96％。结论直肠瓣过宽导致的便秘，行直肠瓣挂线手术疗效满意。