经肛门超声检查对一级修复后四度肛门括约肌断裂患者的缺陷和肛门失禁：肛门内外括约肌复合体和耻骨直肠肌的研究。

Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle.

机构信息

Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.

出版信息

Ultrasound Obstet Gynecol. 2009 Dec;34(6):693-8. doi: 10.1002/uog.7478.

DOI:10.1002/uog.7478

PMID:19953561

Abstract

OBJECTIVES

To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist.

METHODS

EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score.

RESULTS

Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1 (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EAUS and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores > or = 4 had a Starck score of > or = 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer.

CONCLUSION

In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of AI was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects.

摘要

目的

对初次修复的四度肛门括约肌破裂（ASR）后进行三维经肛门超声（EAUS）检查，并将超声缺损与肛门失禁（AI）相关联；测量耻骨直肠肌（PRM）的轴向和矢状厚度和角度以及肛管长度，然后将这些测量值与 AI 相关联；评估经验丰富和经验不足的超声医师之间的测量者间一致性。

方法

向 84 例连续女性提供 EAUS，并要求她们在四度 ASR 后回答经过验证的问卷。AI 根据 Wexner 评分分级，EAUS 缺陷根据 Starck 评分分级。

结果

61 名女性（73%）回答了问卷。中位数（范围）随访时间为 5.1（1.3-8.7）年。其中 33 名（54%）女性接受了 EAUS 检查并纳入研究。接受和未接受 EAUS 的女性失禁评分无差异。在接受 EAUS 的 33 名女性（33%）中，11 名女性无失禁，22 名女性（67%）每月至少有一次气体失禁，其中 12 名女性也有液体粪便失禁，2 名女性有固体粪便失禁。中位数 Wexner 评分为 2（范围，0-12）。5 名患者（15%）无超声缺损。所有 Wexner 评分≥4 的患者的 Starck 评分均≥10。然而，未显示超声缺陷与 AI 之间存在相关性，但是 PRM 的角度和产次与 Starck 评分相关。未显示 PRM 测量值与 AI 之间存在明显相关性。有经验的观察者检测到的小缺陷比无经验的观察者多。