盆腔脏器多重造影在出口梗阻性便秘诊断中的应用

目的：研究出口梗阻性便秘(outlet obstructive constipation，OOC)病人盆腔器官及盆底形态结构变化。方法：对38例OOC病人及12例正常自愿受试者行排粪造影检查，结合盆腔、膀胱造影，及在女性阴道内放置浸钡标志物(以下简称“多重造影”)测量肛直角、会阴位置、盆底腹膜位置、膀胱位置情况。结果：经多重造影诊断直肠内脱垂37例，直肠前突5例，盆底痉挛综合征5例。经物理检查上述诊断分别为12例、4例、1例，所有病例均得到造影证实。多重造影检查还发现盆底及腹膜疝9例，膀胱脱出6例，会阴下降综合征3例，子宫后倒或脱垂10例。与对照组相比，OOC组力排相肛直角增大，静息相及力排相会阴异常下降，力排相Douglas陷凹加深；OOC组中有泌尿系症状者静息相及力排相膀胱异常下降。结论：多重造影诊断直肠内脱垂和直肠前突的阳性率明显高于物理诊断；对临床症状隐匿、物理检查难以诊断的盆底腹膜疝，以及膀胱、子宫和阴道脱出提供了诊断依据，有助于选择正确合理的治疗方式。

A combination of pelvicography and colpocystodefecography and defecography for the diagnosis of outlet obstructive constipation

Objective To study the morphologic and structural changes of the pelvic floor and corresponding visceras in patients with outlet obstructive constipation (OOC). Methods We used simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography in 38 patients with OCC and 12 healthy volunteers. Anorectal angle, the level of perineum, and bladder were measured. Results Internal rectal prolapse (IRP) in 37 cases, rectocele (RC) in 5 cases and spastic pelvic floor syndrome (SPFS) in 5 cases were diagnosed by PCCD. While common physical examination alone detected only 12 cases, 4 RC cases and one SPFS case, which were confirmed by PCCD. Moreover, PCCD found 9 cases of pelvic floor hernia or peritoneoceles, 6 cases of cystoceles, 3 cases of descending perineum syndromes, and 10 cases of uterine prolapses. Compared with controls, OOC patients had a larger anorectal angle during defecation, abnormal descending of perineum at rest and defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms have an abnormal descent of bladder during rest and defecation. Conclusion PCCD has a higher detection rate than common physical examination in diagnosing IRP and RC, and provides information for diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD helps in the selection of a proper surgical procedure for OOC patients.