摘要
目的研究出121梗阻性便秘（OOC）患者盆底形态变化和盆腔脏器间的相互关系。方法对59例经物理检查初步诊断为OOC的患者和12例正常自愿者行排粪造影，结合盆底、膀胱造影，女性阴道放置浸钡标记物（四重造影）检查，测量肛直角、会阴位置、盆底腹膜位置、膀胱位置。结果在59例OCC患者中，经盆腔四重造影诊断直肠内脱垂46例，盆底腹膜疝29例，直肠前突7例，盆底肌痉挛综合征7例，会阴下降综合征5例；还发现膀胱脱垂6例，子宫后倾或脱垂10例。与正常自愿者相比，OOC组力排相肛直角明显增大（P〈0．05），静息相和力排相会阴异常下降（P〈0．05，P〈0．01），力排相盆底腹膜位置下降非常显著（P〈0．01）。OOC组中伴泌尿系症状者静息相和力排相膀胱位置均显著低于正常自愿者（P〈0．05，P〈0．01）。结论盆腔四重造影可有效诊断直肠内脱垂和直肠前突：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、子宫脱垂提供了诊断依据；有助于选择正确合理的治疗方法。
Objective To study the changes in pelvic floor morphology and relationships of the pelvic organs in patients with outlet obstructive constipation （OOC）. Methods Fifty-nine OOC patients and 12 healthy volunteers were examined by simultaneous pelvic four-constrast defecography, including pelvicography, vaginal opacification, voiding cystography and defecography.The levels of perineum, peritoneum and bladder, and anorectal angle were measured and recorded. Results Among the 59 OOC patients,46 cases of internal rectal prolapse （IRP）, 29 cases of pelvic floor hernia, 7 cases of rectocele （RC）, 7 cases of spastic pelvic floor syndrome （SPFS）, 5 cases of descending perineum syndrome were diagnosed by pelvic four-constrast defecography. Six cystoceles and 10 uterine prolapses were also found by pelvic four-constrast defecography. Compared with healthy volunteers, OOC patients had significantly large anorectal angles during defecation （P〈0.05）, abnormality descending of per/neum during rest and defecation （P〈0.05, P〈0.01 ）, and a deep pouch of Douglas during defecation （P〈0.01）. OOC patients combined with urinary system symptoms had an abnormal descent of the bladder during rest and defecation（P〈0.05 ,P〈0.01 ）. Conclusion Pelvic four-constrast defecography is an effective method for the diagnosis of IRP, RC, pelvic floor hernia, peritoneocele, cystocele and uterine prolapse, and is helpful in the selection of proper surgical procedures for the treatment of OOC.
出处
《中华胃肠外科杂志》
CAS
2007年第2期111-114,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
四重造影
盆腔
便秘
出口梗阻性
诊断
Pelvic four-constrast defecography
Outlet obstructive constipation
Diagnosis
