Rieger N A, Sweeney J L, Hoffmann D C, Young J F, Hunter A
Colorectal Unit, Royal Adelaide Hospital, Australia.
Dis Colon Rectum. 1996 Aug;39(8):860-4. doi: 10.1007/BF02053983.
This study was undertaken to audit the results of endoanal ultrasound in patients with fecal incontinence.
Endoanal ultrasound was used to investigate 53 patients with fecal incontinence. Data for endoanal ultrasound were collected prospectively. Results were compared with clinical and obstetric history, obtained retrospectively from case notes, and were compared with manometric and operative findings.
Sphincter abnormalities were identified in 42 of 53 patients. A total of 28 anterior defects were thought to be obstetric in origin. Fourteen other defects were secondary to anal pathology or surgery. Patients with anterior external sphincter defects either had complete defects (4 patients; mean age, 31 years) or proximal defects (24 patients; mean age, 55 years). For patients with a proximal defect, 38 percent gave a history of obstetric tear, episiotomy, or forceps delivery, and the rest declared having had an apparently normal delivery. Only 50 percent had a sphincter weakness that was evident on clinical examination. Of those studied with manometry, only 21 percent had low squeeze pressures consistent with an external sphincter defect.
Sphincter defects seen on ultrasound may not have a history of obstetric trauma or abnormal clinical and manometric findings. Endoanal ultrasound is recommended in all patients with fecal incontinence to detect occult sphincter defects.
本研究旨在审核肛门内超声检查对大便失禁患者的检查结果。
采用肛门内超声对53例大便失禁患者进行检查。前瞻性收集肛门内超声检查数据。将结果与从病例记录中回顾性获取的临床和产科病史进行比较，并与测压及手术结果进行比较。
53例患者中有42例发现括约肌异常。共有28例前部缺损被认为源于产科因素。其他14例缺损继发于肛门病变或手术。前部外括约肌缺损患者中，部分患者存在完全缺损（4例；平均年龄31岁），部分患者存在近端缺损（24例；平均年龄55岁）。对于存在近端缺损的患者，38%有产科撕裂、会阴切开术或产钳助产史，其余患者称分娩过程看似正常。临床检查中仅50%的患者存在明显的括约肌无力。在接受测压检查的患者中，仅21%的患者挤压压力低，符合外括约肌缺损表现。
超声检查发现的括约肌缺损患者可能无产科创伤史，临床及测压结果也可能无异常。建议对所有大便失禁患者进行肛门内超声检查，以发现隐匿的括约肌缺损。
