经会阴超声与MRI排粪造影诊断女性出口梗阻型便秘的临床价值 [中文引用][英文引用]

【摘要】目的 以X线排粪造影为金标准，探讨经会阴超声、MRI排粪造影两种影像学技术对女性出口梗阻型便秘的临床诊断价值。方法 选取2020年1月至2021年12月于南京市中医院肛肠科就诊，临床诊断为出口梗阻型便秘的女性患者41例，同时进行X线排粪造影、经会阴超声、MRI排粪造影三种影像学检查。以X线排粪造影为参考标准，评价经会阴超声和MRI排粪造影对直肠前突、会阴下降、直肠黏膜内套叠、肠疝、盆底痉挛诊断的敏感度和特异度，并对三种影像学的诊断结果进行一致性检验。结果 以X线排粪造影为参考标准，经会阴超声诊断直肠黏膜内套叠、直肠前突、会阴下降、肠疝、盆底痉挛的敏感性分别为94.12%、87.5%、55.56%、80%、100%，特异性为100%、88.89%、100%、100%、93.33%；MRI排粪造影敏感性分别为70.59%、81.25%、55.56%、60%、63.64%，特异性分别为100%、77.78%、75%、100%、96.67%。经会阴超声在诊断直肠前突、会阴下降方面与X线一致性较高，Kappa系数分别为0.682、0.661；在诊断直肠黏膜内套叠、肠疝、盆底痉挛方面与X线一致性很好，Kappa系数分别为0.845、0.875、0.883。MRI排粪造影在诊断肠疝、盆底痉挛方面与X线一致性较高，Kappa系数分别为0.725、0.660。结论 经会阴超声可以作为女性出口梗阻型便秘的初步评估技术；MRI排粪造影可以作为此类患者病因诊断的有效补充。

 【Abstract】  Objective  To explore the clinical diagnostic value of transperineal ultrasound (TPUS) and MR defecography (MRD) in female outlet obstruction constipation (OOC) by using X-ray defecography (XRD) as the gold standard. Methods  From January 2020 to December 2021, 41 female patients who were clinically diagnosed as OOC in the Department of Anorectal Diseases of Nanjing Hospital of Traditional Chinese Medicine were selected for XRD, TPUS and MRD. With XRD as the reference standard, the sensitivity and specificity of TPUS and MRD in the diagnosis of rectocele, perineal descent, rectal intussusception, enterocele and pelvic floor dyssynergia were evaluated, and the consistency of the three imaging results was tested. Results  Taking XRD as the reference standard, the sensitivity of TPUS in the diagnosis of rectal intussusception, rectocele, perineal descent, enterocele, and pelvic floor dyssynergia was 94.12%, 87.5%, 55.56%, 80%, and 100%, and the specificity was 100%, 88.89%, 100%, 100%, and 93.33%. The sensitivity of MRD in the diagnosis of rectal intussusception, rectocele, perineal descent, enterocele and pelvic floor dyssynergia was 70.59%, 81.25%, 55.5%, 60% and 63.64%, and the specificity was 100%, 77.78%, 75%, 100% and 96.67%. TPUS was highly consistent with XRD in the diagnosis of rectocele and perineal descent, and the Kappa coefficients were 0.682 and 0.661. TPUS has good consistency with XRD in the diagnosis of rectal intussusception, enterocele, pelvic floor dyssynergia, and the Kappa coefficients were 0.845, 0.875, 0.883. MRD was highly consistent with XRD in the diagnosis of enterocele and pelvic floor dyssynergia, and the Kappa coefficients were 0.725 and 0.660. Conclusion  TPUS can be used as a preliminary evaluation technique for female OOC; MRD can be used as an effective supplement to the etiological diagnosis of such patients.