Tsunoda A, Takahashi T, Ohta T, Fujii W, Kiyasu Y, Kusanagi H
Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
Tech Coloproctol. 2016 Mar;20(3):171-6. doi: 10.1007/s10151-015-1423-1. Epub 2016 Jan 12.
Rectoanal intussusception (RAI) is a common finding on evacuation proctography in patients with defecation disorders. However, it remains unclear whether intussusception morphology affects the severity of fecal incontinence (FI). The aim of this study was to examine the effect of morphology during defecation on the severity of FI in patients with RAI.
We included 80 patients with FI who were diagnosed as having RAI on evacuation proctography. Various morphological parameters were measured, and the level of RAI was divided by the extent of descent onto (level I) or into (level II) the anal sphincter. FI symptoms were documented using the FI Severity Index (FISI).
Twenty-eight patients had level I and 52 had level II RAI. The mean (range) FISI score was 24.0 (8-47). FISI scores tended to be significantly higher in level II than in level I [26.3 (10-47) vs. 21.8 (8-42); p = 0.05]. The mean anterior intussusception descent was significantly greater in level II than in level I [24.2 (9.2-39.5) vs. 17.7 (7.8-39.4) mm; p < 0.0001]. Regression analysis showed that anterior intussusception descent was predictive of increased FISI scores.
The severity of FI may be affected by anterior intussusception descent in patients with RAI.
直肠肛管套叠（RAI）是排便障碍患者排粪造影中常见的表现。然而，套叠形态是否影响大便失禁（FI）的严重程度仍不清楚。本研究的目的是探讨排便时的形态对RAI患者FI严重程度的影响。
我们纳入了80例经排粪造影诊断为RAI的FI患者。测量了各种形态学参数，并根据套叠下降至肛门括约肌上（I级）或进入肛门括约肌内（II级）的程度对RAI进行分级。使用FI严重程度指数（FISI）记录FI症状。
28例患者为I级RAI，52例为II级RAI。FISI评分的平均值（范围）为24.0（8 - 47）。II级的FISI评分往往显著高于I级[26.3（10 - 47）对21.8（8 - 42）；p = 0.05]。II级的平均前位套叠下降明显大于I级[24.2（9.2 - 39.5）对17.7（7.8 - 39.4）mm；p < 0.0001]。回归分析表明，前位套叠下降可预测FISI评分增加。
RAI患者的FI严重程度可能受前位套叠下降的影响。
