直肠压力测定联合盆底肌肉张力测定在 阴道后壁膨出诊断中的价值分析

Value of anorectal manometry with pelvic floor muscle tension examination in diagnosis of posterior vaginal wall prolapse

摘要:

目的 通过对盆底脏器脱垂中阴道后壁膨出患者进行直肠肛管压力测定及盆底肌肉张力测定，探 讨其内在相关性，旨在为诊断该疾病提供客观检查指标，探讨临床应用价值。方法 根据患者所具有解剖学及功 能学缺陷不同，分为如下4 组。组1A ：阴道后壁膨出，排便困难。组1B ：阴道后壁膨出，无排便困难。组2 ： 阴道前壁膨出不伴有阴道后壁膨出。组3 ：无盆底功能障碍的阴性对照组。对以上各组患者行盆底肌肉张力 测定和直肠压力测定，观察各项指标的内在联系及临床意义。结果 研究期间，符合录入标准的对象为123 例， 最终纳入该项研究为107 例。组1、组2 与组3 比较，其肛管静息压、肛管缩榨压及盆底最大张力减小。组1 中直肠力排压较组2 减小，肛管力排压较组2 增加。组1A 与组1B 比较，直肠力排压减小，肛管力排压增加， 直肠力排压/ 盆底肌肉张力减小，差异有统计学意义（P <0.05），其他各项参数两组间未见明显异常。结论 直肠压力测定联合盆底肌肉张力测定可作为诊断盆腔脏器脱垂相关性排便出口梗阻疾病的辅助诊查手段。盆 底脏器脱垂导致的排便困难通常具有直肠力排压减小，肛管力排压增大，直肠力排压/ 盆底肌肉张力减小的临 床表现。

Abstract:

Objective To evaluate the predictive capability of anorectal physiologic tests for pelvic outlet obstruction. Methods According to the patients' anatomical and functional defects, they were divided into three groups. The patients with posterior vaginal wall protrusion and difficult defecation were included in the group 1A, the patients with posterior vaginal wall protrusion without difficult defecation were included in the group 1B, the patients with anterior vaginal wall protrusion not accompanied by posterior vaginal wall protrusion were included in the group 2, the people without pelvic floor dysfunction were enrolled into the negative control group. Anorectal manometry and examination of pelvic muscle tension were performed to determine the internal connections and clinical significance of the predictors. Results During the study, 123 subjects met the entry criteria and 107 of them were eventually enrolled in the study. Compared with the control group, anal resting pressure, anal squeezing pressure and the maximal pelvic floor tension decreased in the group 1 and the group 2. The rectal straining pressure in the group 1 was lower than that in the group 2 but the anal straining pressure was higher than that in the group 2. Rectal straining pressure in the group 1A was lower than that in the group 1B (P < 0.05), but anal straining pressure in the group 1A was higher than that in group 1B (P < 0.05). Rectal straining pressure/maximum pelvic floor muscle tension was lower in the group 1A than in the group 1B. Conclusions Anorectal manometry combined with the examination of pelvic muscle tension can be an auxiliary method for diagnosis of posterior pelvic dysfunction. Defecation difficulties caused by pelvic floor organ prolapse usually have the manifestations of decreased rectal straining pressure, increased anal straining pressure, and decrease of rectal straining pressure/pelvic muscle straining tension.