Timor-Tritsch I E, Monteagudo A, Smilen S W, Porges R F, Avizova E
NYU School of Medicine, Division of Ob/Gyn Ultrasound, Department of Obstetrics and Gynecology, New York, NY 10016, USA.
Ultrasound Obstet Gynecol. 2005 Feb;25(2):177-83. doi: 10.1002/uog.1827.
Fecal incontinence affects 0.2% of women aged 15-64 years and about 1.3% of women over 64 years. Most cases are related to instrumental deliveries affecting the anal sphincter complex. We propose a simple technique using the generally available transvaginal transducer to evaluate the anal sphincter complex.
Ninety-two patients underwent ultrasound examination. Group I consisted of 53 nulliparous patients. In Group II there were six patients with normal spontaneous vaginal deliveries without episiotomies. In Group III there were 14 patients with vaginal deliveries and one to three episiotomies but no lacerations. In Group IV there were nine postpartum patients with recently repaired (48 h to 3 weeks) third- and fourth-degree lacerations. All women in Groups I-IV were asymptomatic. Group V consisted of 10 patients symptomatic for fecal incontinence. We used a vaginal probe (5-9-MHz) with the footprint placed in the fourchette pointing towards the anus in a transverse and then in a median (sagittal) plane. If seen, the combined internal and external anal sphincter thickness at the 12 o'clock location was measured. We visualized normal star-shaped mucosal folds on the transverse section and described the sonographic anatomy in both planes.
The mean sphincter thickness measured at 12 o'clock in Group I was 2.3 (range, 1.0-4.7) mm, in Group II it was 2.9 (range, 2.4-3.4) mm, and in Group III it was 2.3 (range, 1.0-3.7) mm. The differences between these three groups were not significant. Patients from Group IV showed thinning or discontinuous sphincter anatomy at the 12 o'clock position. All symptomatic patients from Group V showed abnormal sphincter anatomy, and the normal star-like appearance of the anal mucosa on the transverse section was deformed, radiating from the point of the sphincter damage. Four of the 10 patients in this group underwent surgical repair. In these patients the sonographic findings were confirmed.
The images obtained using this imaging modality show the sphincter muscle anatomy as well as the possible pathology. Due to its simplicity the technique can be applied in any place where a vaginal transducer is available.
大便失禁影响0.2%的15 - 64岁女性以及约1.3%的64岁以上女性。大多数病例与影响肛门括约肌复合体的器械助产有关。我们提出一种使用普遍可用的经阴道探头来评估肛门括约肌复合体的简单技术。
92例患者接受了超声检查。第一组由53例未生育患者组成。第二组有6例自然阴道分娩且未行会阴切开术的患者。第三组有14例阴道分娩且行一至三次会阴切开术但无裂伤的患者。第四组有9例产后近期（48小时至3周）修复三度和四度裂伤的患者。第一至四组的所有女性均无症状。第五组由10例有大便失禁症状的患者组成。我们使用阴道探头（5 - 9兆赫），探头面置于阴唇系带，在横切面然后在正中（矢状）面指向肛门。如果可见，测量12点位置的肛门内括约肌和外括约肌联合厚度。我们在横切面上观察到正常的星状黏膜皱襞，并描述了两个平面的超声解剖结构。
第一组在12点测量的括约肌平均厚度为2.3（范围1.0 - 4.7）毫米，第二组为2.9（范围2.4 - 3.4）毫米，第三组为2.3（范围1.0 - 3.7）毫米。这三组之间的差异不显著。第四组患者在12点位置显示括约肌解剖结构变薄或不连续。第五组所有有症状的患者均显示括约肌解剖结构异常，横切面上肛门黏膜正常的星状外观变形，从括约肌损伤点放射状分布。该组10例患者中有4例接受了手术修复。在这些患者中，超声检查结果得到了证实。
使用这种成像方式获得的图像显示了括约肌肌肉解剖结构以及可能的病理情况。由于其操作简单，该技术可应用于任何有阴道探头的地方。
