Barthet M, Portier F, Heyries L, Orsoni P, Bouvier M, Houtin D, Barriere N, Mambrini P, Salducci J, Grimaud J C
INSERM U315, Marseille, France.
Endoscopy. 2000 Apr;32(4):300-5. doi: 10.1055/s-2000-7385.
The diagnosis of anorectal dynamic disorders and perineal insufficiency has been mainly based up to now on the use of defecography. Here, we performed a prospective blinded study to evaluate the accuracy of a new procedure, dynamic anorectal endosonography (DAE), by comparing it with defecography.
A total of 43 women (mean age 53), presenting with outlet obstruction, were prospectively enrolled in our study. The DAE was performed with a 7.5-Mhz linear probe (Toshiba, Tokyo, Japan) with basal and straining recordings. None of the DAE or defecography operators was informed about the results of the respective other investigation.
Defecography showed a descending perineum in 29 patients (68%), a rectocele in 25 patients (58%), and a rectal intussusception in eight patients (18%). The rate of concordance between the diagnosis of descending urinary bladder at DAE and descending perineum at defecography was 35/43 (80%), and that between the descending puborectal muscle at DAE and descending perineum at defecography was 40/43 (93 %). The rates of concordance between DAE and defecography for the diagnosis of rectocele and rectal intussusception were 27/43 patients (57%) and 34/43 patients (80%), respectively. In the last 15 patients, the DAE technique was adapted in order to improve the accuracy for diagnosing rectocele by filling the rectum with water. This improved sensitivity from 36 to 86% and accuracy from 57 to 87%.
DAE is a new imaging approach to anorectal dynamic disorders, providing a highly reliable means of diagnosing perineal insufficiency as well as rectocele. DAE should be substituted for previous methods since it makes it possible at the same time to assess the anal sphincters and to avoid pelvic irradiation.
迄今为止，肛门直肠动力障碍和会阴功能不全的诊断主要基于排粪造影。在此，我们进行了一项前瞻性双盲研究，通过将一种新的检查方法——动态肛门直肠腔内超声检查（DAE）与排粪造影相比较，来评估其准确性。
共有43名存在出口梗阻的女性（平均年龄53岁）前瞻性纳入本研究。使用7.5兆赫线性探头（日本东京东芝公司）进行DAE检查，并记录静息和用力排便时的情况。DAE或排粪造影的操作人员均未被告知对方检查的结果。
排粪造影显示29例患者（68%）会阴下降，25例患者（58%）直肠膨出，8例患者（18%）直肠套叠。DAE诊断膀胱下降与排粪造影诊断会阴下降之间的一致性率为35/43（80%），DAE诊断耻骨直肠肌下降与排粪造影诊断会阴下降之间的一致性率为40/43（93%）。DAE与排粪造影诊断直肠膨出和直肠套叠的一致性率分别为27/43例患者（57%）和34/43例患者（80%）。在最后15例患者中，对DAE技术进行了改进，通过向直肠内注水来提高诊断直肠膨出的准确性。这使敏感性从36%提高到86%，准确性从57%提高到87%。
DAE是一种用于诊断肛门直肠动力障碍的新的成像方法，是诊断会阴功能不全和直肠膨出的高度可靠手段。DAE应替代以前的方法，因为它能同时评估肛门括约肌并避免盆腔辐射。
