动态经会阴超声对女性排便梗阻综合征诊断价值的研究 [中文引用][英文引用]

 【摘要】目的 以传统X线排粪造影为金标准，评估动态经会阴超声对女性排便梗阻综合征的诊断价值。方法 回顾性分析 2019 年6月至 2021年12月南京中医药大学附属南京中医院收治97例女性排便梗阻综合征患者资料，患者均接受X线排粪造影和动态经会阴超声检查，分别对直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便进行评估，并对两种影像学的诊断结果进行一致性检验。结果 动态经会阴超声诊断直肠前突、直肠黏膜内套叠、肠疝、会阴下降、不协调性排便的灵敏度分别为88%、86%、83%、67%、95%，特异度分别为90%、96%、99%、96%、86%。两种影像学在评估直肠前突分度上显示一致性中等，Kappa系数为0.538；直肠黏膜内套叠、会阴下降和不协调性排便一致性较好，Kappa系数分别为0.727、0.655、0.791；肠疝一致性极好，Kappa系数为0.822。经会阴超声测得静息状态肛直角大于X线排粪造影（121.79±9.54 vs. 112.69±11.73 ，P＜0.05）。结论  动态经会阴超声在诊断女性排便梗阻综合征上显示了较高特异性，是一项有效评估女性排便梗阻综合征的影像学技术。 

 【Abstract】  Objective  To evaluate the value of dynamic transperineal ultrasonography (DTPU) in the diagnosis of female patients with obstructed defaecation syndrome (ODS) using traditional X-ray defecography as the gold standard. Methods  The data of 97 female patients with ODS admitted to Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from June 2019 to December 2021 were retrospectively analyzed. All patients received X-ray defecography and DTPU to evaluate rectocele （RC）, rectal intussusception （RI）, enterocele （EC）, perineal descent （PD） and dyssynergic defecation （DD）, and to test the consistency of the two imaging diagnosis results. Results  The sensitivities of DTPU in the diagnosis of RC, RI, EC, PD and DD were 88%, 86%, 83%, 67% and 95% respectively, and the specificities were 90%, 96%, 99%, 96% and 86% respectively. The two imaging techniques showed moderate consistency in evaluating the grading of RC, with Kappa coefficient of 0.538. The consistencies of RI, PD and DD were good, with Kappa coefficients of 0.727, 0.655 and 0.791 respectively. The consistency of EC was excellent, and Kappa coefficient was 0.822. The anorectal angle （ARA） measured by DTPU at rest was greater than that of X-ray defecography (121.79±9.54 vs. 112.69±11.73, P<0.05). Conclusion  DTPU shows high specificity in the diagnosis of female ODS and it is an effective imaging technique for evaluating female ODS.