Sun Xiaobing, Li Dianguo, Wang Ruoyi, Sun Xiaogang, Liu Qian
Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan 250033, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Mar;17(3):250-3.
To evaluate the application of anal endosonography in the morphology of internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis (PR) in order to provide necessary information for analysis of the etiology of fecal incontinence and formulation of the therapeutic schedule.
From December 2010 to November 2012, 18 children of anorectal malformation (n=14) or Hirschsprung's disease(n=4) with fecal incontinence received anal endosonography. The morphology of IAS, EAS and PR was observed. The damage of anal sphincter was classified according to Starck criteria. Anorectal mamometry and anal clinical score were measured simultaneously. Spearman analysis was performed to examine the correlation of anal sphincter damage with anorectal mamometric score and anal clinical score.
According to Starck criteria, anal sphincter damage was small in 11 children, moderate in 6, and severe in 1. PR damage was found in 4 cases. Starck score was positively correlated with manometric score(P<0.05), while not correlated with anal clinical score(P>0.05).
Anal endosonography can clearly display the morphology of IAS, EAS and PR, and their integrity and damage degree. It is a very valuable technique to evaluate the anal sphincter of the children with fecal incontinence, which however can not reflect the function of anal sphincter and anal continence thoroughly.
评估肛门内超声检查在肛管内括约肌（IAS）、肛管外括约肌（EAS）和耻骨直肠肌（PR）形态学方面的应用，以便为分析大便失禁的病因及制定治疗方案提供必要信息。
2010年12月至2012年11月，对18例患有大便失禁的肛门直肠畸形患儿（n = 14）或先天性巨结肠患儿（n = 4）进行肛门内超声检查。观察IAS、EAS和PR的形态。根据Starck标准对肛门括约肌损伤进行分类。同时测量肛门直肠测压和肛门临床评分。采用Spearman分析检验肛门括约肌损伤与肛门直肠测压评分和肛门临床评分的相关性。
根据Starck标准，11例患儿肛门括约肌损伤轻微，6例中度，1例重度。发现4例PR损伤。Starck评分与测压评分呈正相关（P < 0.05），而与肛门临床评分无相关性（P > 0.05）。
肛门内超声检查可清晰显示IAS、EAS和PR的形态及其完整性和损伤程度。它是评估大便失禁患儿肛门括约肌的一项非常有价值的技术，然而它不能全面反映肛门括约肌功能和肛门节制功能。
