Comparation of DMRD and X-ray defecography in the diagnosis of female outlet obstructive constipation
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摘要:
目的探讨磁共振与X线排粪造影诊断女性出口梗阻型便秘患者的临床价值比较。 方法选取我院肛肠科明确诊断的出口梗阻型便秘患者80例作为研究对象，对患者的X线排粪造影和磁共振排粪造影资料进行回顾性分析，以临床确诊结果作为诊断标准，计算两种造影方式诊断的符合率，对比两种造影对不同病因导致的出口梗阻型便秘病因的诊断差异。 结果以临床确诊病因作为标准，X线排粪造影诊断直肠粘膜脱垂、直肠套叠、结肠疝、小肠疝、会阴下降的符合率均为100%，X线排粪造影诊断膀胱脱垂、子宫脱垂、宫颈旁囊肿、骶骨旁囊肿的符合率均较低，分别为11.76%、8.33%、11.11%、12.50%；磁共振排粪造影诊断骶骨旁囊肿、宫颈旁囊肿、膀胱脱垂、子宫脱垂的符合率均较高，分别为100.00%、8.33%、11.11%、12.50%；磁共振排粪造影诊断直肠套叠、会阴下降、小肠疝、结肠疝、直肠肌痉挛、直肠粘膜脱垂、直肠前突与临床确诊病因的符合率较低；X线排粪造影对直肠前突、直肠粘膜脱垂、直肠套叠、会阴下降的诊断符合率高于磁共振排粪造影，差异有统计学意义（P < 0.05）；磁共振排粪造影对骶骨旁囊肿、宫颈旁囊肿、膀胱脱垂、子宫脱垂的诊断符合率高于X线排粪造影，差异有统计学意义（P < 0.05）。 结论结直肠病变引起的出口梗阻型便秘采用X线排粪造影诊断符合率较高，但是对因膀胱脱垂、子宫脱垂、宫颈旁囊肿、骶骨旁囊肿引起的出口梗阻型便秘诊断敏感性不佳，磁共振排粪造影诊断方式对于X线排粪造影具有较好的补充作用。 Abstract:ObjectiveTo explore the clinical value of MR defecography in diagnosing female patients with outlet obstructive constipation. MethodsWe selected 80 patients with constipation of outlet obstruction who were clearly diagnosed in our hospital's anorectal department. The data of X-ray defecography and MR defecography were retrospectively analyzed. The clinical diagnosis results were used as the diagnostic criteria to calculate the two angiography. The coincidence rate of the method was calculated. The difference of the two types of angiography in the diagnosis of different causes of outlet obstructive constipation were analyzed. ResultsBased on the clinical diagnosis of the cause, the coincidence rate of X-ray defecography in the diagnosis of rectal mucosal prolapse, rectal intussusception, colonic hernia, intestinal hernia, and perineal decline were all 100%. X-ray defecography was used to diagnose bladder prolapse and uterine prolapse. The coincidence rates of parasacral cysts, paracervical cysts, and parasacral cysts were 11.76%, 8.33%, 11.11% and 12.50%, respectively. MR defecography diagnosed parasacral cysts, paracervical cysts, bladder prolapse, and uterine prolapse. The coincidence rates were 100.00%, 8.33%, 11.11% and 12.50%, respectively. MR defecography diagnosed rectal intussusception, perineal descent, small intestinal hernia, colonic hernia, rectal muscle spasm, rectal mucosal prolapse, anterior rectum. The coincidence rate of X-ray defecography with the clinically confirmed etiology was lower. The diagnosis coincidence rate of X-ray defecography for rectal protrusion, rectal mucosal prolapse, rectal intussusception, and perineal descent were higher than that of MR defecography (P < 0.05). The diagnostic coincidence rates of MR defecography for parasacral cyst, paracervical cyst, bladder prolapse, and uterine prolapse were higher than that of X-ray defecography (P < 0.05). ConclusionOutlet obstructive constipation caused by colorectal lesions has a high diagnostic accuracy rate with X-ray defecography. But it is not sensitive to the diagnosis of outlet obstructive constipation caused by bladder prolapse, uterine prolapse, paracervical cyst and parasacral cys. MR defecography diagnosis method has a better complementary effect on X-ray defecography. -
Key words:
- magnetic resonance /
- defecography /
- female /
- outlet obstruction /
- constipation
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图 1 患者女性，63岁，X线及磁共振排粪造影影像学表现
A: X线排粪造影; B: 磁共振排粪造影FIESTA序列静息相; C: 力排充盈相; D: 力排黏膜相.
Figure 1. Female patient, 63 years old, imaging features of X-ray defecography andMRdefecography.
图 2 患者女性，67岁，X线及磁共振排粪造影影像学资料
A: X线排粪造影; B: 磁共振排粪造影FIESTA序列静息相; C: 力排充盈相; D: 力排黏膜相.
Figure 2. Female patient, 67 years old, imaging features of X-ray defecography andMRdefecography.
表 1 X线排粪造影与临床确诊病因的符合率
Table 1. The coincidence rate of X-ray defecography and clinically confirmed etiology
确诊病因 X线排粪造影 符合率（%） 直肠前突（n=22） 19 86.36 直肠粘膜脱垂（n=17） 17 100.00 直肠肌痉挛（n=12） 10 83.33 直肠套叠（n=9） 9 100.00 结肠疝（n=5） 5 100.00 小肠疝（n=5） 5 100.00 会阴下降（n=14） 14 100.00 膀胱脱垂（n=17） 2 11.76 子宫脱垂（n=12） 1 8.33 宫颈旁囊肿（n=9） 1 11.11 骶骨旁囊肿（n=8） 1 12.50 
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表 2 磁共振排粪造影与临床确诊病因的符合率
Table 2. The coincidence rate of MR defecography and clinically confirmed etiology
确诊病因 磁共振排粪造影 符合率（%） 直肠前突（n=22） 11 50.00 直肠粘膜脱垂（n=17） 8 47.06 直肠肌痉挛（n=12） 8 66.67 直肠套叠（n=9） 2 22.22 结肠疝（n=5） 3 60.00 小肠疝（n=5） 2 40.00 会阴下降（n=14） 5 35.71 膀胱脱垂（n=17） 16 94.12 子宫脱垂（n=12） 11 91.67 宫颈旁囊肿（n=9） 8 88.89 骶骨旁囊肿（n=8） 8 100.00
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表 3 磁共振排粪造影与X线排粪造影诊断结果的对比
Table 3. Comparison of diagnosis results between MR defecography and X-ray defecography [n(%)]
确诊病因 X线排粪造影 磁共振排粪造影 χ2 P 直肠前突 19 (86.36) 11 (50.00) 6.705 0.010 直肠粘膜脱垂 17(100.00) 8 (47.06) 12.240 0.000 直肠肌痉挛 10 (83.33) 8 (66.67) 0.889 0.346 直肠套叠 9 (100.00) 2 (22.22) 11.455 0.001 结肠疝 5 (100.00) 3 (60.00) 2.500 0.114 小肠疝 5 (100.00) 2 (40.00) 1.905 0.168 会阴下降 14(100.00) 5 (35.71) 13.263 0.000 膀胱脱垂 2(11.76) 16 (94.12) 23.139 0.000 子宫脱垂 1 (8.33) 11 (91.67) 16.667 0.000 宫颈旁囊肿 1(11.11) 8 (88.89) 10.889 0.001 骶骨旁囊肿 1(12.50) 8 (100.00) 12.444 0.000
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