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阴道后壁脱垂的评估:体格检查结果与膀胱直肠腹膜造影的比较。

Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography.

作者信息

Altman Daniel, López Annika, Kierkegaard Jonas, Zetterström Jan, Falconer Christian, Pollack Johan, Mellgren Anders

机构信息

Pelvic Floor Center Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 182 88, Stockholm, Sweden.

出版信息

Int Urogynecol J Pelvic Floor Dysfunct. 2005 Mar-Apr;16(2):96-103; discussion 103. doi: 10.1007/s00192-004-1220-2. Epub 2004 Sep 14.

Abstract

The aim of the present study was to compare clinical and radiological findings when assessing posterior vaginal wall prolapse. Defecography can be used to complement the clinical evaluation in patients with posterior vaginal wall prolapse. Further development of the defecography technique, using contrast medium in the urinary bladder and intraperitoneally, have resulted in cystodefecoperitoneography (CDP). Thirty-eight women underwent clinical examination using the pelvic organ prolapse quantification system (POP-Q) followed by CDP. All patients answered a standardized bowel function questionnaire. Statistical analysis measuring correlation between POP-Q and CDP using Pearson's correlation coefficient (r) and Spearman's rank order correlation coefficient (rs) demonstrated a poor to moderate correlation, r=0.49 and rs=0.55. Although there was a strong association between large rectoceles (>3 cm) at CDP and symptoms of rectal emptying difficulties (p<0.001), severity and prevalence of bowel dysfunction showed poor coherence with clinical prolapse staging and findings at radiological imaging. Vaginal topography and POP-Q staging predict neither radiological size nor visceral involvement in posterior vaginal wall prolapse. Radiological evaluation may therefore be a useful complement in selected patients.

摘要

本研究的目的是比较评估阴道后壁脱垂时的临床和影像学表现。排粪造影可用于辅助评估阴道后壁脱垂患者的病情。随着排粪造影技术的进一步发展,即在膀胱和腹腔内使用造影剂,出现了膀胱直肠腹膜造影术(CDP)。38名女性先采用盆腔器官脱垂量化系统(POP-Q)进行临床检查,随后接受CDP检查。所有患者均回答了一份标准化的肠道功能问卷。使用Pearson相关系数(r)和Spearman等级相关系数(rs)对POP-Q和CDP之间的相关性进行统计分析,结果显示相关性较差至中等,r = 0.49,rs = 0.55。尽管CDP显示的大直肠膨出(>3 cm)与直肠排空困难症状之间存在强烈关联(p<0.001),但肠道功能障碍的严重程度和患病率与临床脱垂分期及影像学检查结果之间的一致性较差。阴道形态和POP-Q分期既不能预测阴道后壁脱垂的影像学大小,也不能预测内脏受累情况。因此,影像学评估可能是部分患者有用的辅助检查手段。

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