Poen A C, Felt-Bersma R J
Dept of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1999;230:40-8. doi: 10.1080/003655299750025534.
Endosonography may be used for diagnosing various anorectal disorders. This review addresses its technique and clinical use in benign anorectal disease.
The English literature available on anal endosonography was reviewed. The different modalities, the endosonography technique itself and its value in benign anorectal disease were described.
Anal endosonography is easy to perform, has a short learning curve and causes less discomfort than routine digital examination. Anal sphincters can be clearly visualized and distinction is possible between the internal (hypoechoic) and external (hyperechoic) anal sphincters. Other pelvic floor structures, like the puborectalis muscle, can also be visualized. Endosonography is mostly used in the assessment of faecal incontinence; it has brought new insight into the pathophysiological mechanisms of this disorder and can select patients with traumatic incontinence for sphincter repair. It has replaced electromyographical sphincter mapping, which is a painful and time-consuming procedure. In perianal sepsis, endosonography assists in defining fistula tract anatomy. The use of contrast agents has significantly increased the accuracy of endosonography in the assessment of perianal fistulae. In addition, endosonography is an excellent alternative to expensive MRI. Besides its use in incontinence and perianal sepsis, with anal endosonography surgical possibilities can be evaluated in individual patients, for example, to decide whether a sphincter repair or a lateral sphincterectomy is preferable. Finally, endosonography may occasionally identify internal sphincter myopathy in patients with intractable constipation or proctalgia.
Anal endosonography images the internal and external sphincters with high accuracy. It is easy to perform and is especially valuable in the diagnosis of anal incontinence and perianal sepsis.
腔内超声检查可用于诊断各种肛肠疾病。本综述探讨其在良性肛肠疾病中的技术及临床应用。
回顾了有关肛门腔内超声检查的英文文献。描述了不同的检查方式、腔内超声检查技术本身及其在良性肛肠疾病中的价值。
肛门腔内超声检查操作简便，学习曲线短，与常规指诊相比引起的不适更少。肛门括约肌可清晰显示，能区分内括约肌（低回声）和外括约肌（高回声）。其他盆底结构，如耻骨直肠肌，也能显示。腔内超声检查主要用于评估大便失禁；它为该疾病的病理生理机制带来了新的认识，可筛选出适合括约肌修复的创伤性失禁患者。它已取代了痛苦且耗时的肌电图括约肌图谱检查。在肛周脓毒症中，腔内超声检查有助于明确瘘管解剖结构。造影剂的使用显著提高了腔内超声检查评估肛周瘘管的准确性。此外，腔内超声检查是昂贵的磁共振成像的极佳替代方法。除了用于失禁和肛周脓毒症外，通过肛门腔内超声检查还可评估个体患者的手术可能性，例如决定是进行括约肌修复还是侧方括约肌切除术更合适。最后，腔内超声检查偶尔可在难治性便秘或直肠疼痛患者中发现内括约肌肌病。
肛门腔内超声检查能高精度成像内、外括约肌。操作简便，在诊断肛门失禁和肛周脓毒症方面尤其有价值。
