Wickramasinghe Dakshitha Praneeth, Senaratne Supun, Senanayake Hemantha, Samarasekera Dharmabandu Nandadeva
Department of Surgery, University of Colombo, Sri Lanka.
Department of Obstetrics and Gynaecology Faculty of Medicine, University of Colombo, Sri Lanka.
J Ultrasound Med. 2018 Dec;37(12):2821-2827. doi: 10.1002/jum.14640. Epub 2018 Apr 17.
The normal parameters of 3-dimensional endoanal ultrasound (3DEAUS) of the anal sphincter have not been reported for primigravidae or pregnant women at present. 3DEAUS parameters in Asian primigravidae were assessed in this study.
We analyzed 3DEAUS data of 101 consecutives Asian primigravidae, assessed in the early third trimester. The assessment was performed with a rigid ultrasonic probe (Olympus RU 12M-R1 probe and EU-ME1 ultrasound system (Olympus Corp., Shinjuku, Japan). The Wilcoxon signed-rank test was used to detect the differences in pressure in different quadrants.
The participants had a mean age of 24.7 (standard deviation [SD], 5.1) years. The Cleveland Clinic Incontinence Score was normal in all participants. The anal sphincter complex had 3 characteristic segments that were identifiable: upper, middle and lower. The puborectalis muscle was identified as a striated "V"-shaped sling, and its mean thickness was 7.44 (SD, 1.41) mm. The mean thickness of internal (IAS) and external (EAS) sphincters at the mid-sphincter level were 1.78 (SD, 0.59) and 5.49 (SD, 1.21) mm, respectively. The EAS measured 6.02 (SD, 1.07) mm at the lower sphincter level. The statistically significant differences seen in the in quadrants were: the IAS was thicker anteriorly (Z = -2.642; P = .008), the EAS at both midsphincter level (Z = -3.70; P < .001) and lower sphincter level (Z = -7.712; P < .001) was thicker posteriorly, and the IAS was thicker at the 9 o'clock position (Z = -2.081; P = .037). Good symmetry at all 3 levels was seen in the EAS (including the puborectalis muscle).
Normal values of 3DEAUS for primigravidae have been identified and may serve as reference values for other laboratories.
目前尚未报道初产妇或孕妇肛管三维超声（3DEAUS）的正常参数。本研究评估了亚洲初产妇的3DEAUS参数。
我们分析了101例连续的亚洲初产妇在妊娠晚期的3DEAUS数据。评估使用刚性超声探头（奥林巴斯RU 12M-R1探头和EU-ME1超声系统（日本东京新宿区奥林巴斯公司））进行。采用Wilcoxon符号秩检验来检测不同象限压力的差异。
参与者的平均年龄为24.7岁（标准差[SD]，5.1）。所有参与者的克利夫兰诊所失禁评分均正常。肛管括约肌复合体有3个可识别的特征段：上部、中部和下部。耻骨直肠肌被识别为一条横纹“V”形吊带，其平均厚度为7.44（SD，1.41）mm。括约肌中部水平的内括约肌（IAS）和外括约肌（EAS）的平均厚度分别为1.78（SD，0.59）mm和5.49（SD，1.21）mm。EAS在括约肌下部水平测量值为6.02（SD，1.07）mm。各象限观察到的统计学显著差异为：IAS在前方较厚（Z = -2.642；P = 0.008），EAS在括约肌中部水平（Z = -3.70；P < 0.001）和下部水平（Z = -7.712；P < 0.001）在后方较厚，IAS在9点位置较厚（Z = -2.081；P = 0.037）。EAS（包括耻骨直肠肌）在所有3个水平均具有良好的对称性。
已确定初产妇3DEAUS的正常值，可为其他实验室提供参考值。
