超声排粪造影的直肠前突分度与出口梗阻型便秘患者临床症状的相关性研究

目的在前期建立的超声排粪造影基础上，以X线排粪造影直肠前突（RC）分度为金标准，确定超声排粪造影（EDF）的RC分度，并分析此分度与出口梗阻型便秘（OOC）患者临床症状之间的相关性。 方法收集2018年12月至2021年4月于南京中医药大学第二附属医院肛肠诊疗中心就诊的49例RC女性患者，其中37例患者被诊断为OOC，12例患者被诊断为功能性肛门直肠痛（FAP），其中38例患者同时进行X线排粪造影和EDF检查。首先，将38例RC患者两种检查的数值进行线性回归分析，计算出EDF的RC分度；在此基础上，将37例OOC患者的RC分度与其便秘症状进行Logistic回归分析。 结果线性回归分析得出回归方程：y=0.188x+5.973（回归系数P=0.014；常量P=0.001），计算出EDF的RC分度为轻度：7 mm~9 mm；中度：9 mm~12 mm；重度：＞12 mm；Logistic回归分析结果：RC分度与患者是否自主排便（P=0.738）、肛门坠胀（P=0.894）、腹（胀）痛（P=0.721）以及排便费力（P=0.648）、排便梗阻感（P=0.686）、排便不尽感（P=0.729）、排便次数减少（P=0.108）的轻度症状无明显相关性；而与排便费力（P=0.021；P=0.036）、排便梗阻感（P=0.038；P=0.015）、排便不尽感（P=0.032；P=0.026）、排便次数减少（P=0.008）的中重度症状有较强的相关性，其中与中重度的排便费力密切相关性（P＜0.05）。 结论EDF直肠前突分度与出口梗阻性便秘的临床症状如排便梗阻感、排便不尽感、排便次数减少相关，特别与排便费力密切相关，提示EDF是诊断直肠前突的有效手段；本研究样本量较少，下一步需要通过多中心研究扩大样本量，进一步确定其价值。

The correlation between rectocele grading in echodefecography and clinical symptoms in patients with outlet obstruction constipation

ObjectiveTo establish the grade of rectocele (RC) in echodefecography (EDF) on the basis of the previous establishment of EDF, with a standard of RC grading in X-ray defecography (X-ray). And analyze the correlation between the grading and the clinical symptoms of outlet obstruction constipation(OOC). MethodsForty-nine female patients diagnosed with RC were studied, collected from December 2018 to April 2021 in the Anorectal Treatment Center of The Second Affiliated Hospital of Nanjing University of Chinese Medicine. Among these, thirty-seven patients were diagnosed with OOC and 12 with functional anorectal pain (FAP). Both X-ray and EDF were performed in 38 patients. First, the values of the two examinations of 38 patients with RC were analyzed by linear regression, and the RC grading of EDF was calculated. On this basis, Logistic regression analysis was conducted on the RC grading of 37 OOC patients and their constipation symptoms. ResultsThe regression equation was obtained by linear regression analysis: y=0.188x+5.97 3 (regression coefficient; P=0.014; constant: P=0.001). According to X-ray criteria, the mild one in EDF was 7 mm~9 mm,the moderate one was 9 mm~12 mm and the severe one was over 12 mm. Logistic regression analysis results: there was no significant correlation between RC grading and patients' self-defecation (P=0.738), anal pendant expansion (P=0.894), abdominal (distension) pain (P=0.721) and mild symptoms of defecation difficulty (P=0.648), sense of defecation obstruction (P=0.686), sense of defecation failure (P=0.729), decrease of defecation frequency (P=0.108). But there was a strong correlation with moderate and severe symptoms such as defecation difficulty (P=0.021; P=0.036), sense of defecation obstruction (P=0.038; P=0.015), sense of defecation failure (P=0.032; P=0.026), decrease of defecation frequency (P=0.008), of which the correlation with moderate and severe defecation difficulty was the largest (P＜0.05). ConclusionThe RC grading in EDF was associated with clinical symptoms of OOC,such as defecation difficulty, sense of defecation obstruction, sense of defecation failure, decrease of defecation frequency, and especially closely related to defecation difficulty. It suggests that EDF is an effective method to diagnose RC. The sample size of this study was small, so the next step is to expand the sample size for further exploration and multi-center study to further determine its value.