Poen A C, Felt-Bersma R J, Cuesta M A, Meuwissen G M
Department of Surgery, University Hospital 'Vrije Universiteit', Amsterdam, the Netherlands.
Br J Surg. 1998 Mar;85(3):359-63. doi: 10.1046/j.1365-2168.1998.00616.x.
Anal endosonography is an established technique in the evaluation of anorectal disease. However, it is sometimes difficult to visualize the anterior part of the sphincter complex and anal endosonography may be impossible when anal pain or stenosis is present. The aim of this study was to evaluate vaginal endosonography in the diagnosis of faecal incontinence and perianal sepsis.
Anal and vaginal endosonography were performed in 56 women with faecal incontinence (n = 36) or perianal sepsis (n = 20). The technique and pelvic floor anatomy were described, anal sphincter measurements with anal and vaginal endosonography were compared, and the additive value of vaginal over anal endosonography in the diagnosis of faecal incontinence and perianal sepsis was assessed.
The pelvic floor was clearly imaged with vaginal endosonography. However, after a relatively short learning curve it was still not possible to image the anal sphincters in three of 28 patients. Except for external anal sphincter thickness, which was significantly lower, all anal canal structure measurements were greater with vaginal than with anal endosonography. Concerning the diagnosis of either faecal incontinence or perianal sepsis, vaginal endosonography added important information in comparison with anal endosonography in 14 (25 per cent) of 56 patients.
Vaginal endosonography provides reliable images of the anal sphincters in an undistorted fashion, thereby increasing the diagnostic yield of faecal incontinence and perianal sepsis in 25 per cent of patients. Therefore, endosonographists should become acquainted with this technique.
肛门内超声检查是评估肛肠疾病的一项成熟技术。然而，有时难以清晰显示括约肌复合体的前部，并且当存在肛门疼痛或狭窄时，肛门内超声检查可能无法进行。本研究的目的是评估阴道内超声检查在诊断大便失禁和肛周脓毒症中的作用。
对56例患有大便失禁（n = 36）或肛周脓毒症（n = 20）的女性进行肛门和阴道内超声检查。描述了该技术和盆底解剖结构，比较了肛门和阴道内超声检查对肛门括约肌的测量结果，并评估了阴道内超声检查相对于肛门内超声检查在诊断大便失禁和肛周脓毒症方面的附加价值。
阴道内超声检查能清晰显示盆底。然而，经过相对较短的学习曲线后，28例患者中有3例仍无法显示肛门括约肌。除了肛门外括约肌厚度明显较低外，阴道内超声检查测得的所有肛管结构测量值均大于肛门内超声检查。关于大便失禁或肛周脓毒症的诊断，在56例患者中有14例（25%），阴道内超声检查相对于肛门内超声检查增加了重要信息。
阴道内超声检查能以未受干扰的方式提供可靠的肛门括约肌图像，从而使25%的患者大便失禁和肛周脓毒症的诊断率提高。因此，超声检查医师应熟悉这项技术。
