医学检查与临床诊断

孤立性直肠溃疡综合征患者的X线排粪造影和MR排粪造影的影像学表现

  • 李桂婷 ,
  • 胡美玉 ,
  • 曾志明 ,
  • 谢佩怡 ,
  • 邸小慧
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  • 中山大学附属第六医院放射诊断科、广东省结直肠盆底疾病研究重点实验室 (广州 510650 )

收稿日期: 2023-09-26

  网络出版日期: 2024-04-08

基金资助

广东省科技创新战略专项资金(临床医学研究中心)项目(2020B1111170004);广东省医学影像智能分析与应用重点实验室开放课题项目(2022-MKF-05)

Imaging findings of X⁃ray defecography and MR defecography in patients with solitary rectal ulcer syndrome

  • Guiting LI ,
  • Meiyu HU ,
  • Zhiming ZENG ,
  • Peiyi XIE ,
  • Xiaohui DI
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  • Department of Radiology,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Sixth Affiliated Hospital,Sun Yat?sen University,Guangzhou 510650,China

Received date: 2023-09-26

  Online published: 2024-04-08

摘要

目的 回顾性总结分析孤立性直肠溃疡综合征(SRUS)患者的X线排粪造影(XRD)和MR排粪造影(MRD)的影像学表现,为临床诊疗提供重要信息。 方法 19例经临床、病理和肠镜检查证实的SRUS患者纳入本研究,15例行XRD,7例行MRD,3例患者同时进行了XRD和MRD检查。收集所有患者的数据并进行盆底功能测量。 结果 在XRD结果中,3例(20%)表现直肠内套叠,8例(53.3%)直肠外脱垂,2例(13.3%)中度直肠前突。另外耻骨直肠肌肥厚患者有2例,膀胱脱垂和子宫脱垂患者各有1例。在MRD结果中,3例(42.9%)表现直肠黏膜脱垂(部分性脱垂),4例(57.1%)直肠前突患者中,3例(均为女性)为中度直肠前突,1例为轻度直肠前突。3例患者同时观察到相关的前、中腔室器官下降,2例耻骨直肠肌肥厚,没有患者表现乙状结肠疝。 结论 排粪造影可以评估SRUS患者的直肠外脱垂、直肠前突、直肠黏膜脱垂、直肠内套叠等盆底结构及功能异常,对SRUS患者的治疗具有指导意义。

本文引用格式

李桂婷 , 胡美玉 , 曾志明 , 谢佩怡 , 邸小慧 . 孤立性直肠溃疡综合征患者的X线排粪造影和MR排粪造影的影像学表现[J]. 实用医学杂志, 2024 , 40(6) : 850 -856 . DOI: 10.3969/j.issn.1006-5725.2024.06.020

Abstract

Objective The imaging findings of X?ray defecography (XRD) and magnetic resonance defecography (MRD) of patients with Solitary Rectal Ulcer syndrome (SRUS) were retrospectively analyzed to provide important information for clinical diagnosis and treatment. Methods 19 patients with SRUS confirmed by clinical, pathological and colonoscopy were included in this study. Among them, 15 patients underwent XRD and 7 patients underwent MRD, and 3 patients underwent both XRD and MRD. Data of all enrolled patients were collected and pelvic floor function was measured. Results In the results of XRD, 3 patients (20%) showed rectal intussusception. 8 patients (53.3%) showed external rectal prolapse and 2 patients (13.3%) showed moderate rectocele. In addition, there were 2 patients of puborectal muscle hypertrophy, and 1 patient of bladder prolapse and uterine prolapse, respectively. For MRD, 3 patients (42.9%) showed rectal mucosal prolapse (partial prolapse). At 4 patients (57.1%) with rectocele, 3 patients (all female) had moderate rectocele, 1 patient had mild rectocele. 3 patients were also observed related anterior and middle compartment organ descent. 2 patients of pubulorectal muscle hypertrophy, no sigmoidocoele. Conclusion Defecography can evaluate the structural and functional abnormalities of pelvic floor in SRUS patients, such as external rectal prolapse, rectal protrusion, rectal mucosal prolapse, and rectal intussusception, which has guiding significance for the treatment of SRUS patients。

参考文献

1 FOROOTAN M, DARVISHI M. Solitary rectal ulcer syndrome: A systematic review[J]. Medicine (Baltimore), 2018, 97(18):e0565. doi:10.1097/md.0000000000010565
2 SHARARA A I, AZAR C, AMR S S, et al. Solitary rectal ulcer syndrome: endoscopic spectrum and review of the literature[J]. Gastrointest Endosc, 2005, 62(5): 755-762. doi:10.1016/j.gie.2005.07.016
3 李冬琳, 管仲安. 孤立性直肠溃疡综合征的研究进展[J/CD]. 世界最新医学信息文摘, 2022, 21(53): 104-105.
4 SAYED R F EL, ALT C D, MACCIONI F, et al. Magnetic resonance imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group[J]. Eur Radiol, 2017, 27(5): 2067-2085. doi:10.1007/s00330-016-4471-7
5 YANG A, MOSTWIN J L, ROSENSHEIN N B, et al. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display[J]. Radiology, 1991, 179(1): 25-33. doi:10.1148/radiology.179.1.2006286
6 ABDELATTY M A, HALLIGAN S, SAYED R F EL, et al. Solitary rectal ulcer syndrome (SRUS): observational case series findings on MR defecography[J]. Eur Radiol, 2021, 31(11):8597-8605. doi:10.1007/s00330-021-08075-6
7 IACOBELLIS F, REGINELLI A, BERRITTO D, et al. Pelvic floor dysfunctions: how to image patients?[J]. Jpn J Radiol,2020, 38(1): 47-63. doi:10.1007/s11604-019-00903-6
8 王晨晓, 张敏, 石荣, 等. 动态磁共振排粪造影盆底功能评估测量指标的应用现况和比较[J]. 影像诊断与介入放射学, 2022, 31(4): 291-298. doi:10.3969/j.issn.1005-8001.2022.04.008
9 刘玉意, 赖碧玉. 磁共振排粪造影扫描技术在排便障碍性疾病中的应用探讨[J]. 影像研究与医学应用, 2022, 6(6): 145-147. doi:10.3969/j.issn.2096-3807.2022.06.049
10 LI M, JIANG T, PENG P, et al. MR defecography in assessing functional defecation disorder: diagnostic value of the defecation phase in detection of dyssynergic defecation and pelvic floor prolapse in females[J]. Digestion, 2019, 100(2): 109-116. doi:10.1159/000494249
11 HALLIGAN S, SULTAN A, ROTTENBERG G, et al. Endosonography of the anal sphincters in solitary rectal ulcer syndrome[J]. Int J Colorectal Dis, 1995, 10(2): 79-82. doi:10.1007/bf00341201
12 FAROUK EL SAYED R. The urogynecological side of pelvic floor MRI: the clinician′s needs and the radiologist′s role[J]. Abdom Imaging, 2013, 38(5): 912-929. doi:10.1007/s00261-012-9905-3
13 邱洪明, 郭光远, 王燕, 等. 直肠前突的X线和磁共振排粪造影研究[J].医学影像学杂志, 2012, 22(1): 111-114. doi:10.3969/j.issn.1006-9011.2012.01.037
14 MORTELE K J, FAIRHURST J. Dynamic MR defecography of the posterior compartment: indications, techniques and MRI features[J]. Eur J Radiol, 2007, 61(3): 462-472. doi:10.1016/j.ejrad.2006.11.020
15 丁俞江, 王永兵, 李刚, 等. X线排粪造影与多参数盆底动态MRI对盆底痉挛综合征及其相关的复合型病变的诊断价值研究[J]. 结直肠肛门外科, 2019, 25(4): 462-465.
16 文海洋, 袁强, 陈治坤, 等. 胃肠排空试验联合钡灌肠+排粪造影惯续检查在便秘分型中的应用[J]. 海南医学, 2021, 32(2): 187-191.
17 王蓓蓓, 张照晴, 阎红云, 等. 磁共振与X线排粪造影诊断女性出口梗阻型便秘的对比[J]. 分子影像学杂志, 2021, 44(1): 83-87. doi:10.12122/j.issn.1674-4500.2021.01.16
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