三维超声对耻骨直肠肌变化所致老年性排便障碍的研究

目的探讨三维超声对老年便秘与耻骨直肠肌之间的相关性。 方法回顾收集2015年1月至2017年9月在山东大学附属千佛山医院肛肠科门诊就诊及住院的老年性便秘患者资料43例（观察组）及43例健康志愿者资料（对照组），分别在静息期、力排期和缩肛期行盆底三维超声检查并对三维重建声像图进行分析，测量两组耻骨直肠肌后角大小及肛门截石3、6、9点位耻骨直肠肌的厚度。 结果观察组与对照组耻骨直肠肌后角在静息期［（83.556±2.110）°，（83.804±2.485）°］、缩肛期［（86.836±1.453）°，（86.557±1.375）°］比较差异均无统计学意义（t=-0.499，-0.915；P均>0.05）；在力排期［（79.905±2.381）°，（89.214±1.916）°］比较差异有统计学意义（t=-19.985，P<0.05）；在静息期与力排期耻骨直肠肌后角的差值为［（3.275±1.236）°，（-6.569±1.209）°］，两组比较差异有统计学意义（t=-37.147，P<0.05）。观察组与对照组截石3、6、9点位耻骨直肠肌厚度在静息期［（3.274±0.134）mm，（3.307±0.101）mm；（3.476±0.127）mm，（3.461±0.141）mm；（3.281±0.103）mm，（3.327±0.121）mm］、缩肛期［（3.282±0.154）mm，（3.376±0.113）mm；（3.982±0.214）mm，（4.117±0.173）mm；（3.275±0.134）mm，（3.327±0.119）mm］，两组比较差异无统计学意义（t=-0.407，0.519，-1.901，-1.168，-3.214，-1.898，P均>0.05）；在力排期［（3.731±0.129）mm，（3.216±0.087）mm；（4.271±0.169）mm，（3.596±0.134）mm；（3.724±0.112）mm，（3.221±0.089）mm］差异有统计学意义（t=20.924，20.517，23.073，P均<0.05）；观察组和对照组在静息期与力排期截石3、6、9点位耻骨直肠肌厚度的差值［（-0.426±0.091）mm，（-0.217±0.089）mm；（-0.589±0.137）mm，（-0.289±0.109）mm；（-0.431±0.111）mm，（-0.247±0.091）mm］，差异均有统计学意义（t=-10.773，-11.236，-2.659；P均<0.05）。 结论老年排便障碍患者的耻骨直肠肌后角在力排期较健康志愿者小，肛门截石3、6、9点位耻骨直肠肌厚度较健康志愿者厚，并且静息期与力排期差值越大，便秘程度越严重。

Research of senile dyschesia with the angular and thickness changes of puborectalis muscle based on three-dimensional ultrasound

ObjectiveTo investigate the correlation between senile constipation and puborectal muscles by three-dimensional ultrasound. MethodsFrom January 2015 to September 2017, forty-three cases of senile constipation (observation group) and 43 healthy volunteers (control group) were collected from outpatient and Anorectal Department of Qianfushan Hospital Affiliated to Shandong University. The pelvic floor was examined by three-dimensional ultrasonography in resting period, forced drainage period and anal contraction period respectively. The size of posterior angle of puborectal muscle and the thickness of puborectal muscle at 3, 6 and 9 points of anal lithotomy were measured. ResultsThe posterior horn of puborectalis muscle of the observation group and the control group was at rest [(83.556±2.110)°, (83.804±2.485)°], anal contraction period [(86.836±1.453)°, (86.557±1.375)°], there was no significant difference between the two groups (t=-0.499, -0.915; P>0.05). At the time of force release [(79.905±2.381)°, (89.214±1.916)°], the difference was significant (t=-19.985, P<0.05).The difference of posterior angle of puborectalis muscle between resting period and force-displacement period was [(3.275±1.236)°, (-6.569±1.209)°], there were significant differences between the two groups (t=-37.147, P<0.05). The puborectal muscle thickness at 3, 6 and 9 points of lithotomy in the observation group and the control group was [(3.274±0.134) mm, (3.307±0.101) mm; (3.476±0.127) mm, (3.461±0.141) mm; (3.281±0.103) mm, (3.327±0.121) mm] during the rest period. During anal contraction was [(3.282±0.154) mm, (3.376±0.113) mm; (3.982±0.214) mm, (4.117±0.173) mm; (3.275±0.134) mm, (3.327±0.119) mm], there was no significant difference between the two groups (t=-0.407, 0.519, -1.901, -1.168, -3.214, -1.898; P>0.05).There were significant differences in the duration of force release [(3.731±0.129) mm, (3.216±0.087) mm; (4.271±0.169) mm, (3.596±0.134) mm; (3.724±0.112) mm, (3.221±0.089) mm] (t=20.924, 20.517, 23.073; P<0.05). The difference of puborectal muscle thickness between the observation group and the control group at 3, 6 and 9 points of lithotomy was [(-0.426±0.091) mm, (-0.217±0.089) mm; (-0.589±0.137) mm, (-0.289±0.109) mm; (-0.431±0.111) mm, (-0.247±0.091) mm], the difference was statistically significant (t=-10.773, -11.236, -2.659; P<0.05). ConclusionThe posterior angle of puborectalis muscle in elderly patients with defecation disorder was smaller than that in healthy volunteers in force-displacement period, and the thickness of puborectalis muscle at 3, 6 and 9 points of anal lithotomy was thicker than that in healthy volunteers. And the greater the difference between resting period and forced expiration period, the more severe the degree of constipation.