摘要
目的:比较排粪造影、CT及MRI三种影像学检查方法对耻骨直肠肌综合征的诊断价值及限度,为临床检查方法的选择、外科手术治疗及术后康复评估提供理论依据。方法:1988-03/2004-04解放军第三军医大学大坪医院野战外科研究所普通外科经诊断证实且均进行了排粪造影、CT和MRI三种影像学检查的62例耻骨直肠肌综合征患者,分别测量出肛直角及耻骨直肠肌压迹长度、深度和厚度并与56例健康自愿者的排粪造影、CT和MRI检查结果进行对照分析。结果:正常人肛直角力排相较静息相明显增大。耻骨直肠肌综合征患者中49例肛直角力排相较静息相明显减小,且均伴有耻骨直肠肌压迹,耻骨直肠肌压迹长度(3.52±0.65)cm,深度(1.68±0.49)cm,另外13例静息、力排时肛直角均无变化,钡剂不排或少排且均出现“搁架征”。CT,MRI断面图像上,耻骨直肠肌综合征患者耻骨直肠肌厚度明显较正常人厚,差异有非常显著性意义(P<0.01)。且还能清晰显示出盆底肌群、筋膜及其周围间隙。结论:排粪造影能显示耻骨直肠肌功能性异常,是诊断耻骨直肠肌综合征较可靠的方法。CT,MRI能直接清楚地显示耻骨直肠肌位置、形态大小、与邻近结构的关系及各部分的发育情况等,并更进一步了解耻骨直肠肌综合征患者的解剖结构改变、邻近结构异常及盆底其他功能性疾病。
AIM:To compare the value and limit of three imaging examination methods,i.e.,e xcretion contrast,CT and MRI in the diagnosis of puborectalis syndrome(PRS) so a s to provide a theoretical basis for the choice of clinical examination,surgical treatment and postoperative assessment of rehabilitation. METHODS:The excretion contrast,CT and MRI examinations were performed in 62 pa tients who were diagnosed with PRS in Department of General Surgery,Research Ins titute of Surgery,Daping Hospital,Third Military Medical University of Chinese P LA from March 1988 to April 2004.Their anorectal angle(ARA),length and depth of ARA impression as well as the thickness of the puborectalis muscle were measured to compare with those of 56 healthy persons also measured by excretion contrast ,CT and MRI examinations. RESULTS:In normal persons,ARA at maximum exertion was significantly increased as compared with that at rest.In 49 out of the 62 cases of PRS,ARA at maximum ex ertion was obviously reduced as compared with that at rest and associated with p uborectalis muscles impression,with the length for (3.52±0.65) cm and depth for (1.68±0.49) cm.In the other 13 cases,ARA showed no changes either at maximum e xertion or at rest.A little or no excretion of barium appeared together with“sh elving syndrome'.The transverse image of CT and MRI showed that the puborectalis of PRS patients was thicker than that of normal persons,with significant differ ence(P< 0.01),and showed clearly pelvic floor muscle,fasciae and peripheral crev ice. CONCLUSION:The excretion contrast is a reliable method for the diagnosis of PR S because it can manifest the abnormal function of the puborectalis muscles.In t he meantime,CT and MRI can clearly display the position,growth status and size o f the puborectalis muscles as well as its relation with adjacent structures,whic h provides further understandings on anatomical changes,adjacent abnormal struct ure and other functional diseases of pelvic floor in PRS patients.Therefore,an a ppropriate combination of three methods plays an important role in the early and comprehensive diagnosis of PRS and in guidance for surgical treatment as well a s postoperative assessment of rehabilitation.
出处
《中国临床康复》
CSCD
北大核心
2005年第14期9-11,i001,共4页
Chinese Journal of Clinical Rehabilitation
