Leniushkin A I, Pankevich T L, Lukin V V
Khirurgiia (Mosk). 1992 Nov-Dec(11-12):45-9.
The article shows the wide possibilities of computed tomography (CT) diagnosis of the topography of muscles forming the external sphincter of the anus (ESA) in patients with developmental anorectal anomalies and in trauma and rupture of the perineum. It is shown that in anorectal anomalies with fistulas opening into the urinary system the puborectal muscular sling is "drawn up" ventrally in relation to the external sphincter elements lying closer to the surface. Analysis of the results of CT examination of the pelvic floor in 16 children with anorectal anomalies showed that the degree of development of the sphincter muscles does not always correspond to the level of atresia. For instance, the mass of the ESA muscles is manifested more in some forms of cloacal atresia than in "tubular" stenoses of the rectum (anorectal stenosis--Curravino-triad component) (G. Curravino, 1981). CT examination of children with this complex of caudal anomalies allowed the authors to reveal a fourth constant component: dysplasia of the pelvic floor and a specific developmental anomaly of the anal sphincter. CT is the method of choice in the examination of children with this pathological condition because it makes it possible to recognise the presence of presacral masses. The use of CT in traumas and ruptures of the perineum allows the depth and extension of ruptures of the ESA muscles to be authentically determined.
本文展示了计算机断层扫描（CT）在诊断患有肛门直肠发育异常以及会阴创伤和破裂患者的肛门外括约肌（ESA）形成肌肉的局部解剖方面的广泛可能性。结果表明，在伴有通向泌尿系统瘘管的肛门直肠异常中，耻骨直肠肌吊带相对于更靠近体表的外括约肌成分向腹侧“上提”。对16例肛门直肠异常儿童的盆底CT检查结果分析表明，括约肌肌肉的发育程度并不总是与闭锁水平相对应。例如，ESA肌肉的质量在某些形式的泄殖腔闭锁中比在直肠“管状”狭窄（肛门直肠狭窄——库拉维诺三联征组成部分）中表现得更明显（G. 库拉维诺，1981年）。对患有这种尾部异常综合征儿童的CT检查使作者能够发现第四个恒定组成部分：盆底发育不良和肛门括约肌的特定发育异常。CT是检查患有这种病理状况儿童的首选方法，因为它能够识别骶前肿块的存在。在会阴创伤和破裂中使用CT可以准确确定ESA肌肉破裂的深度和范围。
