Colorectal Surgery, Surgical Department, Faculty of Medicine, University of Alexandria, Egypt.
Int J Surg. 2010;8(4):274-82. doi: 10.1016/j.ijsu.2010.02.008. Epub 2010 Feb 26.
Surgical treatment of obstructed defecation (OD) carries frequent recurrences. The aim of the study was to evaluate the role dynamic magnetic resonance imaging defecography, and to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients in order to minimize failures.
Forty consecutive constipated patients with OD symptoms (31 females) with mean age 48.15+/-14.29 years. They underwent perineal examination, proctoscopy, anorectal manometry and Dynamic MRI defecography. The different pelvic floor morphology was recorded. The type and outcome of treatment whether conservative or surgical were also recorded.
The dynamic MRI of the pelvic floor showed 23 patients with descending perineum, 32 rectoceles (28 females), 12 cystoceles (10 females), 6 enteroceles (4 females), 18 intussusceptions (14 females), and 7 dyskinetic puborectalis muscle (3 females). The diagnosis of combined pelvic floor disorders with dynamic MRI defecography was consistent with clinical results in 70% and there were additional diagnostic parameters in 30% of patients. Dynamic MRI findings changed treatment decision in 8 patients 20% with surgical treatment performed in 25 patients (8 stappled trans-anal rectal resection, 11 trans-anal Delorme's, 6 trans-abdominal combined repair), and conservative treatment in 15 patients.
Dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in OD and interdisciplinary treatment.
排便障碍（OD）的手术治疗常复发。本研究旨在评估动态磁共振排粪造影的作用，并阐明这些患者盆底障碍的潜在解剖和病理生理基础，以最大限度地减少失败。
连续 40 例有 OD 症状的便秘患者（31 名女性），平均年龄 48.15+/-14.29 岁。他们接受了会阴检查、直肠镜检查、肛肠测压和动态 MRI 排粪造影。记录了不同的盆底形态。还记录了治疗的类型和结果，无论是保守治疗还是手术治疗。
盆底的动态 MRI 显示 23 例会阴下降，32 例直肠前突（28 名女性），12 例膀胱前突（10 名女性），6 例肠膨出（4 名女性），18 例内套叠（14 名女性），和 7 例动力性耻骨直肠肌（3 名女性）。动态 MRI 诊断联合盆底障碍与临床结果一致的有 70%，另外 30%的患者有附加诊断参数。动态 MRI 结果改变了 8 例患者（20%）的治疗决策，其中 25 例患者（8 例吻合器经肛门直肠切除术、11 例经肛门 Delorme 修补术、6 例经腹联合修补术）接受了手术治疗，15 例患者接受了保守治疗。
动态磁共振成像在女性中是一种方便的诊断程序，在男性中则不那么方便，特别是在排便时对盆底器官的动态成像方面。除了临床评估外，动态磁共振成像对 OD 和跨学科治疗有临床影响。
