超声排粪造影在盆底失弛缓便秘诊断中的价值

目的在前期建立的超声排粪造影基础上，以肛管直肠测压（ARM）为标准以此确定超声排粪造影（EDF）在盆底失弛缓疾病（Anismus）上的临床分度，并分析盆底失弛缓便秘患者临床症状与临床分度之间的相关性。 方法收集2018年12月至2021年12月于南京中医药大学第二附属医院肛肠诊疗中心就诊的97例盆底失弛缓便秘患者，在获得患者知情同意下对97例患者都进行肛管直肠测压（ARM）、慢性便秘严重程度评分量表（CSS）及超声排粪造影检查（EDF）。首先，将肛管直肠测压诊断为反常收缩病人进行CSS量表评分，再进行超声排粪造影，将CSS量表评分结果及EDF所测得数值进行线性回归，得到线性回归方程，计算出盆底失弛缓在超声排粪造影上的临床分度。在此基础上，再将EDF临床分度与其患者便秘症状进行Logistic回归分析研究，探索在EDF下盆底失弛缓患者临床分度与临床症状的相关性。 结果线性回归分析得出回归方程：y=0.586x-1.191（P＜0.05），计算出EDF的盆底失弛缓分度为：轻度1°＜ɑ≤5°，中度5°＜ɑ≤10°，重度10°＜ɑ≤16°；Logistic回归分析结果：盆底失弛缓患者的EDF临床分度与患者是否自主排便、排便次数、肛门坠胀、腹（胀）痛无明显相关性（P＞0.05）；而与排便费力、排便梗阻感、排便不尽感有较强的相关性（P＜0.05）。 结论盆底失弛缓患者EDF临床分度与临床症状如排便不尽感、排便梗阻感、排便费力密切相关，提示EDF是诊断盆底失弛缓的有效手段；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。

Value of echodefecography in diagnosis of constipation secondary to anismus

ObjectiveTo grade anismus by echodefecography (EDF) based on standard anismus grading by anorectal manometry (ARM), and analyze the correlation between the grade of anismus and the clinical symptoms of constipation. MethodsNinety-seven patients diagnosed with anismus were collected from December 2018 to December 2021 at the Anorectal Treatment Center of The Second Affiliated Hospital of Nanjing University of Chinese Medicine. After providing informed consent, the patients underwent ARM, chronic constipation severity scale (CSS) evaluation, and EDF. First, the patient showing abnormal contractions on anorectal manometry were scored on the CSS scale, and then EDF was performed. Anismus was then graded by EDF. On this basis, Logistic regression analysis was conducted for the anismus grade of patients and their constipation symptoms. ResultsThe following regression equation was obtained by linear regression analysis: y=0.586x-1.191 (P＜0.05). According to the CSS, anismus was graded by EDF as follows: mild, 1°＜ɑ≤5°; moderate, 5°＜ɑ≤10°; severe, 10°＜ɑ≤16°. Logistic regression analysis demonstrated that there was no significant correlation between anismus grade and patients' self-defecation, defecation frequency, anal pendant expansion, or abdominal (distension) pain (P＞0.05). However, anismus grade had a strong correlation with symptoms such as sense of bowel movement, defecation obstruction, and sense of defecation failure (P＜0.05). ConclusionAnismus grade evaluated by EDF is associated with clinical symptoms of anismus, such as bowel movement, defecation obstruction, and sense of defecation failure, which suggests that EDF is an effective method to diagnose anismus. The sample size of this study was small, so further larger-sample multi-center study is needed to determine its value.