Benezech A, Bouvier M, Grimaud J-C, Baumstarck K, Vitton V
Service de Gastroentérologie, Hôpital Nord, University Hospital, APHM, Marseille, France.
Colorectal Dis. 2014 May;16(5):O170-5. doi: 10.1111/codi.12522.
Three-dimensional high-resolution anorectal manometry (3DHRAM) is a new technique that can simultaneously provide physiological and topographical data on the terminal part of the digestive tract. Our object was to assess whether 3DHRAM is able to reliably diagnose excessive perineal descent already diagnosed with conventional defaecography, which is considered to be the gold standard.
All patients referred to our centre for anorectal manometry and conventional defaecography were evaluated with a maximum of 6 months between the two examinations. Anorectal manometry was performed using the 3D High-Resolution Given Imaging® probe. Excessive perineal descent was defined as the downward movement of the anal high-pressure zone during straining. At the end of the straining effort, the high-pressure zone regained its initial position, thereby indicating that the probe had not moved.
Nineteen female patients of median age 53 (21-70) years were included in the study. All cases with excessive perineal descent diagnosed using defaecography were visualized with 3DHRAM. The degree of perineal descent determined by 3D and conventional defaecography was compared (Spearman correlation 0.726, P = 0.01). In contrast, the averages measured were significantly different; the average was 11.68 ± 3.3 mm for 3DHRAM but 34.21 ± 13.3 mm for conventional defaecography (P = 0.002).
The results of the study demonstrate that 3DHRAM can diagnose excessive perineal descent with the same degree of reliability as defaecography. Quantitative measures were not correlated, however, possibly because of methodological differences. The study confirms the value of the morphological data provided by 3DHRAM.
三维高分辨率肛肠测压法（3DHRAM）是一项能够同时提供消化道末端生理和地形数据的新技术。我们的目的是评估3DHRAM能否可靠地诊断出已通过传统排粪造影确诊的会阴过度下降，传统排粪造影被认为是金标准。
所有因肛肠测压和传统排粪造影转诊至我们中心的患者，在两次检查之间最多间隔6个月进行评估。使用3D高分辨率Given Imaging®探头进行肛肠测压。会阴过度下降定义为用力排便时肛门高压区向下移动。在用力排便结束时，高压区恢复到初始位置，从而表明探头未移动。
19名年龄中位数为53岁（21 - 70岁）的女性患者纳入研究。所有通过排粪造影诊断为会阴过度下降的病例，3DHRAM均能显示。比较了3D和传统排粪造影确定的会阴下降程度（Spearman相关性为0.726，P = 0.01）。相比之下，测量的平均值有显著差异；3DHRAM的平均值为11.68±3.3毫米，而传统排粪造影为34.21±13.3毫米（P = 0.002）。
研究结果表明，3DHRAM能够以与排粪造影相同的可靠性诊断会阴过度下降。然而，定量测量结果不相关，可能是由于方法学差异。该研究证实了3DHRAM提供的形态学数据的价值。
