From the Department of Gynecology and Obstetrics, Division of Urogynecology, Stanford University Hospital, Palo Alto, CA.
Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):18-22. doi: 10.1097/SPV.0000000000000719.
Our primary objective was to determine the association between rectocele size on defecography and physical examination in symptomatic patients. Our secondary objective was to describe the associations between both defecography and physical examination findings with defecatory symptoms and progression to surgical repair of rectocele.
We performed a retrospective review of all patients referred to a female pelvic medicine and reconstructive surgery clinic with a diagnosis of rectocele based on defecography and/or physical examination at a single institution from 2003 to 2017. Patients who did not have defecatory symptoms, did not undergo defecography imaging, or did not have a physical examination in a female pelvic medicine and reconstructive surgery clinic within 12 months of defecography imaging were excluded.
Of 200 patients, 181 (90.5%) had a rectocele diagnosed on defecography and 170 (85%) had a rectocele diagnosed on physical examination. Pearson and Spearman tests of correlation both showed a positive relationship between the rectocele size on defecography and rectocele stage on physical examination; however, one was not reliable to predict the results of the other (Pearson correlation = 0.25; Spearman ρ = 0.29). The strongest predictor of surgery was rectocele stage on physical examination (P < 0.001). Size of rectocele on defecography was not a strong independent predictor for surgery (P = 0.01), although its significance improved with the addition of splinting (P = 0.004).
Our results suggest that rectocele on defecography does not necessarily equate to rectocele on physical examination in patients with defecatory symptoms. Rectocele on physical examination was more predictive for surgery than rectocele on defecography.
我们的主要目的是确定排便造影中直肠前突的大小与症状患者体检之间的关系。我们的次要目的是描述排便造影和体检结果与排便症状以及直肠前突手术修复的进展之间的关系。
我们对 2003 年至 2017 年期间，在一家医疗机构因排便造影和/或体检诊断为直肠前突的所有患者进行了回顾性研究，这些患者在女性盆腔医学和重建手术诊所进行了排便造影和体检。排除没有排便症状、没有进行排便造影成像或在排便造影成像后 12 个月内没有在女性盆腔医学和重建手术诊所进行体检的患者。
在 200 名患者中，181 名（90.5%）在排便造影中诊断出直肠前突，170 名（85%）在体检中诊断出直肠前突。Pearson 和 Spearman 相关性检验均显示排便造影中直肠前突的大小与体检中直肠前突的分期之间存在正相关关系；然而，一种方法并不可靠地预测另一种方法的结果（Pearson 相关系数=0.25；Spearman ρ=0.29）。手术的最强预测因素是体检中的直肠前突分期（P<0.001）。排便造影中直肠前突的大小不是手术的强独立预测因素（P=0.01），尽管随着支撑的加入，其意义有所提高（P=0.004）。
我们的结果表明，在有排便症状的患者中，排便造影中的直肠前突不一定等同于体检中的直肠前突。体检中的直肠前突比排便造影中的直肠前突更能预测手术。
