Klijn Aart J, Asselman Marino, Vijverberg Marianne A W, Dik Pieter, de Jong Tom P V M
University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
J Urol. 2004 Nov;172(5 Pt 1):1986-8. doi: 10.1097/01.ju.0000142686.09532.46.
We proved the accuracy of the transverse diameter of the rectum on ultrasonography as an additional parameter for diagnosing constipation in children with lower urinary tract dysfunction.
The diameter of the rectum on bladder ultrasonography in a constipated group of patients with dysfunctional voiding was compared to this diameter in a control group of patients with a normal defecation pattern. A total of 49 children were included. Group 1 consisted of 23 patients with a positive history of dysfunctional voiding and, according to pediatric gastroenterological practice, constipation. Control group 2 consisted of 26 patients without lower urinary tract dysfunction and a normal defecation pattern. In each group a defecation questionnaire was administered and physical examination of the abdomen was done. In all patients a 7.5 MHz probe was used to measure the transverse diameter of the rectum behind the bladder on ultrasonography. The probe was applied on the abdominal skin approximately 2 cm above the symphysis. Measurement was performed with a filled bladder at an angle of about 15 degrees downward from the transverse plane.
In constipated group 1 the mean diameter of the rectum was 4.9 cm (95% CI 4.4 to 5.3). In the control group the mean diameter of the rectum was 2.1 cm (95% CI 1.8 to 2.4). In group 1 the diameter of the rectum was significantly larger than in group 2 (p < 0.001). None of the patients had a sensation to defecate during the investigation. There was no significant difference in age between the 2 groups (p = 0.20) and no significant difference between them in the period between the last time that stool was passed prior to the time of rectal measurement (p = 0.16).
The transverse diameter of the rectum measured by lower abdominal ultrasound provides an additional accurate parameter with which to diagnose constipation in patients with nonneurogenic bladder-sphincter dyssynergia.
我们证实了超声检查中直肠横径作为诊断下尿路功能障碍儿童便秘的一项附加参数的准确性。
将功能性排尿障碍便秘组患者膀胱超声检查时的直肠直径与排便模式正常的对照组患者的直肠直径进行比较。共纳入49名儿童。第1组由23名有功能性排尿障碍阳性病史且根据儿科胃肠病学实践诊断为便秘的患者组成。对照组2由26名无下尿路功能障碍且排便模式正常的患者组成。每组均进行排便问卷调查并进行腹部体格检查。所有患者均使用7.5MHz探头在超声检查时测量膀胱后方直肠的横径。探头置于耻骨联合上方约2cm的腹部皮肤上。在膀胱充盈时从横断面以约15度向下的角度进行测量。
便秘的第1组直肠平均直径为4.9cm（95%可信区间4.4至5.3）。对照组直肠平均直径为2.1cm（95%可信区间1.8至2.4）。第1组直肠直径明显大于第2组（p<0.001）。检查期间所有患者均无便意。两组之间年龄无显著差异（p=0.20），且在直肠测量前最后一次排便至测量时的时间段内两组之间也无显著差异（p=0.16）。
通过下腹部超声测量的直肠横径为诊断非神经源性膀胱括约肌协同失调患者的便秘提供了一项额外的准确参数。
