Service de Proctologie Medico Interventionnelle, GH Diaconesses Croix Saint Simon, Paris, France.
Dis Colon Rectum. 2011 Sep;54(9):1129-33. doi: 10.1097/DCR.0b013e3182215034.
Anal incontinence is most often linked with sphincter rupture and/or stretching the pudendal nerves.
The aim of our study was to investigate the involvement of the puborectal part of the levator ani muscle in anal incontinence.
Seventy-eight female patients were studied by anorectal manometry, 3-dimensional ultrasound examination, and concentric needle electromyography of the external anal sphincter, puborectal muscle, and bulbocavernous muscles, completing with the evaluation of the pudendal nerve terminal motor latencies. Damage to the puborectal muscle was defined by an abnormal ultrasound and/or abnormal electromyography.
Rupture of the anal sphincter apparatus and puborectal muscle was found in 23% and 3.8%. The EMG showed damage to the puborectal part in 39 cases: this was isolated in 4 cases and combined with external anal sphincter damage in 35 patients. Unilateral or bilateral increase in the terminal motor latencies of the pudendal nerves was found in 36% (28/78) of the patients. The frequency of peripheral neurogenic lesions varied from 36% to 90% according to the electromyographic tests used. There was no correlation between puborectal part damage and resting pressure, perception threshold, and maximum tolerable rectal volume. The mean Wexner index score was not increased by the existence of a defect involving the puborectal part found by echography or by damage to the puborectal part shown by the EMG. Investigating puborectal muscle lesions reduced the percentage of idiopathic anal incontinence to 2.5%.
Our study confirms the feasibility and usefulness of combined electromyography and 3-dimensional ultrasound examination of the puborectal muscle in anal incontinence.
肛门失禁通常与肛门括约肌破裂和/或阴部神经拉伸有关。
我们的研究旨在探讨肛提肌耻骨直肠部分在肛门失禁中的作用。
对 78 例女性患者进行肛门直肠测压、三维超声检查、阴部外括约肌、耻骨直肠肌和球海绵体肌的同心针肌电图检查，并评估阴部神经终末运动潜伏期。通过异常超声和/或异常肌电图来定义耻骨直肠肌损伤。
发现肛门括约肌装置和耻骨直肠肌破裂分别占 23%和 3.8%。肌电图显示耻骨直肠部分损伤 39 例：其中 4 例为孤立性损伤，35 例与外括约肌损伤相结合。36%（28/78）的患者发现阴部神经终末运动潜伏期单侧或双侧增加。根据肌电图检查的不同，周围神经源性病变的频率从 36%到 90%不等。耻骨直肠部分损伤与静息压力、感知阈值和最大耐受直肠容量无关。Wexner 指数评分均值不因超声检查发现的耻骨直肠部分缺陷或肌电图显示的耻骨直肠部分损伤而增加。研究耻骨直肠肌病变将特发性肛门失禁的比例降低至 2.5%。
我们的研究证实了联合肌电图和三维超声检查耻骨直肠肌在肛门失禁中的可行性和有用性。
