Fukata R, Iwai N, Yanagihara J, Iwata G, Kubota Y
Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Japan.
J Pediatr Surg. 1997 Jun;32(6):839-42. doi: 10.1016/s0022-3468(97)90632-1.
Anal endosonography, electromyography (EMG) of the external anal sphincter (EAS), and manometry of the internal anal sphincter (IAS) were performed in 15 patients with anorectal anomalies (10 with high and five with intermediate anomalies), ranging in age from 8 to 18 years. The anal endosonographic findings were compared with those for the EMG of the EAS and manometry of the IAS. An image including the hyperechoic band that corresponds to the EAS was obtained in all 15 patients. However, the distribution of EAS image was inadequate in high anomalies. In four patients who showed in Kelly score of 5 or 6, good visualization of the EAS was obtained in both anal endosonography and EMG. An Image including the hypoechoic band that corresponds to the IAS was obtained in five patients with high anomalies and in one with intermediate anomalies. Therefore, even in patients with anomalies, at these levels the IAS could be ultrasonically detected. However, only one of these six patients exhibited an anorectal reflex. These results indicate that, for the EAS, the findings of anal endosonography correspond well with those of EMG, but that for the IAS, they do not correspond with those of manometry. At the time of surgery for anorectal anomalies care should taken to preserve the IAS, which can be detected by anal endosonography even in patients with high or intermediate anomalies.
对15例年龄在8至18岁的肛肠畸形患者（10例高位畸形和5例中位畸形）进行了肛管内超声检查、肛门外括约肌（EAS）肌电图（EMG）检查以及肛门内括约肌（IAS）测压。将肛管内超声检查结果与EAS的EMG检查结果以及IAS的测压结果进行比较。所有15例患者均获得了包含对应EAS的高回声带的图像。然而，在高位畸形中EAS图像的分布不充分。在凯利评分5或6分的4例患者中，肛管内超声检查和EMG均获得了良好的EAS可视化图像。在5例高位畸形患者和1例中位畸形患者中获得了包含对应IAS的低回声带的图像。因此，即使在畸形患者中，在这些层面上也可以通过超声检测到IAS。然而，这6例患者中只有1例表现出肛肠反射。这些结果表明，对于EAS，肛管内超声检查结果与EMG结果吻合良好，但对于IAS，它们与测压结果不吻合。在进行肛肠畸形手术时，应注意保留IAS，即使在高位或中位畸形患者中，也可通过肛管内超声检查检测到IAS。
