Dietz H P, Zhang X, Shek K L, Guzman Rojas R
Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia,
Int Urogynecol J. 2015 Sep;26(9):1355-9. doi: 10.1007/s00192-015-2709-6. Epub 2015 May 6.
Rectocele is a common condition, which on imaging is defined by a pocket identified on Valsalva or defecation. Cut-offs of 10 and 20 mm for pocket depth have been described. This study analyses the correlation between rectocele depth and symptoms of bowel dysfunction to define a cut-off for the diagnosis of "significant rectocele" on ultrasound.
A retrospective study using 564 archived data sets of patients seen at tertiary urogynaecological clinics. Patients underwent a standardised interview including a set of questions regarding bowel function, and translabial 3D/4D ultrasound. Assessments were undertaken supine and after voiding. Rectocele depth was measured on Valsalva.
Out of 564, data on symptoms was missing in 18 and ultrasound volumes in 25, leaving 521. Mean age was 56 years (range 18-86), mean BMI 29 (17-56). Presenting symptoms were prolapse (51 %), constipation (21 %), vaginal digitation (17 %), straining at stool (46 %), incomplete bowel emptying (41 %) and faecal incontinence (10 %). A clinically significant rectocele (ICS POPQ stage ≥2) was found in 48 % (n=250). In 261 women a rectal diverticulum was identified, of an average depth of 17 (SD, 7) mm. On ROC statistics a cut- off of 15 mm in depth provided optimal sensitivities of 66 % for vaginal digitation and 63 % for incomplete emptying, and specificities of 52 and 57 % respectively.
Rectocele depth is associated with symptoms of obstructed defecation. A "clinically significant" rectocele may be defined as a diverticulum of the rectal ampulla of ≥15 mm in depth, although poor test characteristics limit clinical utility of this cut-off.
直肠膨出是一种常见病症，在影像学上通过在瓦尔萨尔瓦动作或排便时发现的囊袋来定义。已有关于囊袋深度10毫米和20毫米的截断值描述。本研究分析直肠膨出深度与肠功能障碍症状之间的相关性，以确定超声诊断“重度直肠膨出”的截断值。
一项回顾性研究，使用了在三级泌尿妇科诊所就诊患者的564份存档数据集。患者接受了标准化访谈，包括一组关于肠功能的问题，并进行了经阴唇三维/四维超声检查。在仰卧位和排尿后进行评估。在瓦尔萨尔瓦动作时测量直肠膨出深度。
564例中，18例缺少症状数据，25例缺少超声图像数据，剩余521例。平均年龄56岁（范围18 - 86岁），平均体重指数29（17 - 56）。主要症状为脱垂（51%）、便秘（21%）、阴道指诊感（17%）、排便时用力（46%）、排便不尽（41%）和大便失禁（10%）。48%（n = 250）的患者存在临床显著直肠膨出（国际尿控学会盆腔器官脱垂定量分期法[ICS POPQ]≥2期）。在261名女性中发现了直肠憩室，平均深度为17（标准差，7）毫米。根据ROC分析，深度截断值为15毫米时，阴道指诊感的最佳敏感度为66%，排便不尽的最佳敏感度为63%，特异度分别为52%和57%。
直肠膨出深度与排便梗阻症状相关。“临床显著”的直肠膨出可定义为直肠壶腹憩室深度≥15毫米，尽管该截断值的检测特征不佳，限制了其临床应用价值。
