Yao Yi-Bo, Yin Hao-Qiang, Wang Hai-Jun, Liang Hong-Tao, Wang Bo, Wang Chen
Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China.
Department of Ultrasonic, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China.
Gastroenterol Rep (Oxf). 2021 May 29;9(5):461-469. doi: 10.1093/gastro/goab019. eCollection 2021 Oct.
Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory. This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.
In this pilot study, participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019. All participants separately underwent defecation proctography at sitting and squatting positions, and undertook transperineal ultrasonography at left lateral, sitting, and squatting positions. The consistency of ultrasonography and defecography was evaluated.
Thirty female volunteers with rectocele were included in this study. The degree of anorectal angle was significantly larger at rest and during contraction, maximal Valsalva, and evacuation; the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation; and the length of the perineum descending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography. The degree of anorectal angle, the depth of rectocele, the area of levator hiatus, and the volume of the rectocele were significantly different in using squatting, sitting, and left lateral positions when performing the transperineal ultrasonography. Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.
The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.
多年来，经会阴超声检查一直被用作直肠膨出的诊断成像方式。然而，超声检查与排粪造影在评估直肠膨出严重程度方面的一致性并不理想。本研究旨在评估两种方法在不同体位下测量直肠膨出参数的一致性，并为直肠膨出的诊断提供临床启示。
在这项前瞻性研究中，于2017年12月至2019年12月期间在一家三级医院的门诊招募参与者。所有参与者分别在坐位和蹲位进行排粪造影，并在左侧卧位、坐位和蹲位进行经会阴超声检查。评估超声检查与排粪造影的一致性。
本研究纳入了30名患有直肠膨出的女性志愿者。在静息、收缩、最大瓦尔萨尔瓦动作和排便时，肛管直肠角的度数显著增大；在最大瓦尔萨尔瓦动作和排便时，直肠膨出的深度显著加深；在进行排粪造影时，与坐位相比，蹲位时收缩和最大瓦尔萨尔瓦动作期间会阴下降的长度显著更长。在进行经会阴超声检查时，蹲位、坐位和左侧卧位时肛管直肠角的度数、直肠膨出的深度、提肛裂孔面积和直肠膨出的体积有显著差异。布兰德-奥特曼半定量图显示，在坐位和蹲位时，排粪造影与超声检查在肛管直肠角和直肠膨出深度的测量上具有良好的一致性。
我们研究的结果可被视为支持将坐位和蹲位经会阴超声检查作为评估直肠膨出患者的首选成像检查的初步证据。
