Hencke Jonathan, Staubach Raphael, Loff Steffan
Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Kriegsbergstrasse 62, 70174 Stuttgart, Germany.
Diagnostics (Basel). 2025 Apr 24;15(9):1078. doi: 10.3390/diagnostics15091078.
Distinguishing between the anatomical variant of an anterior anus and mild forms of imperforate anus with rectoperineal fistula often requires inspection, calibration, and, in uncertain cases, electrical stimulation (ES) under general anesthesia. Anorectal manometry (AM), despite its ability to assess sphincter configuration and function, is rarely reported as a diagnostic tool. This study evaluated the utility of AM in such cases. A retrospective analysis of AM and clinical data from 38 patients (35 female, 3 male) with suspected anterior anus was conducted from October 2009 to September 2021. Water-perfused catheter probes with eight radial channels were used to perform pull-through maneuvers. Sphincter locations were identified through vector reconstruction, and pressure ratios of the anterior part to the circumference were recorded. Results were compared to clinical data, including ES findings. Statistical significance was assessed using Mann-Whitney U and Chi-Square tests. Following AM, ES was unnecessary in 25 patients. Of the remaining patients, 83% showed abnormal sphincter configurations on ES, and seven underwent anoplasty. Patients with abnormal sphincter complexes demonstrated significantly lower mean anterior pressures (61.2 mmHg vs. 136.4 mmHg, U = 336.5, = 0.001) and a trend toward lower anterior-to-circumferential pressure ratios (mean 0.42 vs. 0.85, U = 613, = 0.270). Constipation was also more frequent in this group ((1, = 38) = 4.1, = 0.044). Average anterior pressures < 75 mmHg and ratios < 0.7 indicated an anus outside the sphincter complex (sensitivity 80%, specificity 90%). AM proves valuable for evaluating ambiguous anterior anus cases, potentially reducing reliance on ES under general anesthesia. 3D high-resolution AM may further increase diagnostic accuracy.
区分前肛门解剖变异与伴有直肠会阴瘘的轻度肛门闭锁往往需要进行检查、校准，在情况不明时还需要在全身麻醉下进行电刺激（ES）。尽管直肠肛管测压法（AM）能够评估括约肌形态和功能，但很少被报道作为一种诊断工具。本研究评估了AM在此类病例中的效用。对2009年10月至2021年9月期间38例疑似前肛门患者（35例女性，3例男性）的AM和临床数据进行了回顾性分析。使用带有八个径向通道的水灌注导管探头进行牵拉操作。通过矢量重建确定括约肌位置，并记录前部与圆周的压力比。将结果与临床数据（包括ES结果）进行比较。使用曼-惠特尼U检验和卡方检验评估统计学意义。AM检查后，25例患者无需进行ES。在其余患者中，83%在ES检查中显示括约肌形态异常，7例接受了肛门成形术。括约肌复合体异常的患者平均前部压力显著较低（61.2 mmHg对136.4 mmHg，U = 336.5，P = 0.001），前部与圆周压力比有降低趋势（平均0.42对0.85，U = 613，P = 0.270）。该组便秘也更常见（χ²(1, = 38) = 4.1，P = 0.044）。平均前部压力<75 mmHg且比值<0.7表明肛门位于括约肌复合体之外（敏感性80%，特异性90%）。AM对于评估不明确的前肛门病例很有价值，可能减少对全身麻醉下ES的依赖。三维高分辨率AM可能会进一步提高诊断准确性。
