动态经会阴超声与X线排粪造影（Dynamic transperineal ultrasound vs. defecography）

节选自（M. Beer-Gabel, M. Teshler, E. Schechtman and A.P. Zbar

Dynamic transperineal ultrasound  vs. defecography in patients with evacuatory difficulty: a pilot study  Int J Colorectal Dis (2004) 19:60?67）

 Recently the use of transperineal ultrasonog-raphy in normal individuals [9, 10] and dynamic trans-perineal ultrasound (DTP-US) in those with functional anorectal disorders [11, 12] has been described, provid-ing a simple means of assessment of all compartments of浙江中医药大学附属第二医院消化内科刘福
the lower pelvis and perineum and their interaction at rest during straining and defecation.

DTP-US imaging technique
All procedures were videotaped for orthograde and retrograde scrolling of dynamic images and static representative images were used for clinical measurement. DTP-US was performed using cur-vilinear transducers (C 4-7 and C 8-12) and a linear-array trans-ducer (L 5-10 ATL, HDI 3000, Advanced Technology Laborato-ries, Bothell, Wash., USA). The transperineal approach has been previously described by our group [12]. Briefly, before com-mencement of the procedure the patient’s rectum was filled with 50 ml ultrasonographic coupling gel (Ultra-Gel, Aquarius 101,Medilab USA) using a standard Luer syringe and a soft-end cathe-ter. A similar volume of acoustic gel was instilled into the vagina and gel was liberally applied to the perineum. Patients were ad-vised to avoid micturition for a minimum of 2 h prior to the proce-dure. Gastrografin (50 ml) diluted 1:1 with tap water was ingested by the patient 1 h prior to each procedure. The perineum of the pa-tient was examined in the left-lateral position. Images of the infra-levator viscera and soft tissues and the pelvic floor musculature were obtained at rest and during maximal straining for routine visualization of the pubis, urethra, bladder, vagina, anus, distal rectum, and puborectalis muscle, all of which were registered by the examiner. All examinations were performed by the same clini-cian (M.B.G.) who was blinded to the results of defecography.Axial images of the anal sphincter were identified with the probe placed in a sagittal plane and then rotated through 180°whereas coronal images of the anal canal and sphincter muscula-ture were made by holding the transducer head in a transverse plane near (but not in) the introitus. Sagittal examination of the anterior perineum showed the distal vagina, bladder, and urethra and was used to identify contrast-filled enteric loops (if present)
between the rectal and vaginal walls in the territory of the recto-vaginal septum. Towards the end of the procedure patients were ncouraged to evacuate as much of the intrarectal gel as possible.Specific quantitative measurements were made as outlined pre-viously [12] and shown in Fig. 1, where the ARA is calculated at he confluence of a line forming the longitudinal axis of the anal anal with that of the posterior border of the rectal wall at rest and uring evacuation of rectal gel. The movement of the ARJ was easured in a coordinate system defined by an axis which lies erpendicular to a line which touches the posterior aspect of the RJ, and which joins a horizontal axis passing through the mid-point between the superior and inferior borders of the pubic sym-physis. The vertical distance between the ARJ and this horizontal xis can be seen to vary during maximal straining, permitting the etermination of ARJ displacement. The resting position of the norectal junction and its measured movement on straining was ompared with those values obtained during defecography. The epth of a rectocele (when demonstrated by DTP-US) was also easured. This measurement is made by constructing two axes, ne drawn perpendicular to the horizontal axis which passes hrough the projected contrast line of the anterior aspect of the anal canal, and the other parallel to the horizontal axis passing
through the most anterior part of the rectocele. The distance be-tween the two lines represents the measured depth of the rectocele.

9. Rubens DJ, Strang JG, Bogineni-Misra , Wexler IE (1998) Transperineal
sonography of the rectum: anatomy nd pathology revealed by sonography
compared with CT and MR imaging. JR Am J Roentgenol 170:637?642
10. Kleinübing H Jr, Jannini JF, Malafaia , Brenner S, Pinho M (2000) Trans-
perineal ultrasonography: new method o image the anorectal region.
Dis Colon Rectum 43:1572?1574
11. Piloni V (2001) Dynamic imaging of he pelvic floor with transperineal so- ography. Tech Coloproctol 5:103?105
12. Beer-Gabel M, Teshler M, Barzilai N, urie Y, Malnick S, Bass D, Zbar AP
(2002) Dynamic trans-perineal ultra-sound (DTP-US)?a new method for
the diagnosis of pelvic floor disorders: echnical details and preliminary re-
sults. Dis Colon Rectum 45:239?248