排粪造影力排时与提肛时肛直角及其变化诊断盆底失弛缓征的价值

目的：提高盆底失弛缓征排粪造影诊断水平。方法：回顾性分析45例明确诊断为盆底失弛缓征患者及20例排便正常者的排粪造影X线影像,在侧位照片上测量力排时和提肛时的肛直角（ARA）,并计算两组的肛直角差。结果：病例组力排时和提肛时肛直角及其差分别为（96.8±3.9）°、（85.3±2.1）°、（9.8±5.1）°,对照组分别为（120.5±7.8）°、（80.2±6.5）°、（41.6±3.9）°,两组肛直角差之间差异有极显著性意义（P〈0.01）。其中,27例盆底痉挛综合征患者力排时和提肛时肛直角变化较小,为（7.6±1.8）°,且力排肛直角〈90°;15例耻骨直肠肌综合征患者力排、提肛肛直角变化很小,仅（2.8±1.3）°,且力排肛直角≤90°;3例肛门内括约肌失弛缓综合征患者力排肛直角增大（〉100°）,肛直角差较大,为（12.6±4.1）°。三者两两比较肛直角差之间差异存在极显著性意义（P〈0.01）。结论：提肛、力排肛直角及其变化对盆底失弛缓征的诊断有重要价值。

Value of the ARA at Defecation and Lift, and the Difference between Them for Anismus' Diagnosis

Objective：To improve the diagnosis level of defecography（DF） for anismus.Methods：The X-ray images of DF in 45 cases of anismus and 20 volunteers were retrospectively analyzed.The anorectal anagle（ARA） at defecation and lift was measured,and the difference between them was calculated.Results：The ARA in patients group at defecation,lift and difference between them were（96.8±3.9）°,（85.3±2.1）°,and（9.8±5.1）°,respectively,and those in normal control group were（120.5±7.8）°,（80.2±6.5）°,and（41.6±3.9）° respectively.There was significant difference in ARA between two groups（P〈0.01）.Of these,the ARA in 27 patients with spastic pelvic floor syndrome（SPFS） changed a little at defecation and lift（7.6±1.8）°,and the ARA at defecation 90°.The ARA in 15 cases of puborectalis syndrome（PRS） changed even little（2.8±1.3）°,and the ARA at defecation ≤90°.The ARA in 3 cases of achalasia sphincter ani internus（ASAI） at defecation was enlarged（〉100°）,and the ARA′s change between defecation and lift enlarged（12.6±4.1）°.The ARA′s changes among the SPFS,PRS and ASAI were significant（P〈0.01）.Conclusion：The ARA at defecation and lift and the difference between them were very important for the diagnosis of anismus.