Endosonographic elastography of the anal sphincter in patients with fecal incontinence
Endosonographic elastography of the anal sphincter in patients with fecal incontinence
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DOI：
10.3109/00365520903383251
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发表时间：
2010-01-01
影响因子：
1.9
通讯作者：
Dietrich, C. F.
中科院分区：
文献类型：
--
作者：
Allgayer, H.;Ignee, A.;Dietrich, C. F.
客观的。弹性成像在大便失禁中的作用尚未得到评估。我们进行了一项试验，以进一步表征大便失禁患者的肛门内括约肌和肛门外括约肌，并将视觉评估量表与量化肛门括约肌弹性特性的计算机程序进行比较。材料和方法。对 50 名连续大便失禁患者进行了研究（n = 31 例下位前切除术后，n = 8 例克罗恩病患者，n = 9 例结肠手术后，n = 2 例其他患者）。使用视觉模拟标度和离线计算机面积计算程序对代表弹性特性的括约肌内的弹性图颜色分布进行量化。结果。主要发现是，内部肛门括约肌（IAS）与外部肛门括约肌（EAS）在弹性图颜色分布方面存在显着差异。与临床和功能参数没有显着相关性。然而，与未接受照射的患者相比，接受新辅助照射的直肠癌或宫颈癌患者 IAS 中蓝色（硬）区域的百分比没有显着增加，同时伴随着静息括约肌压力显着下降（p < 0.009）。结论。 IAS（平滑肌）和 EAS（横纹肌）具有不同的弹性图颜色分布，可能反映了它们不同的弹性特性。与主要临床和功能参数缺乏显着相关性表明，在常规临床实践中，超声实时弹性成像可能无法为大便失禁患者提供额外信息。可能会有例外，特别是在接受辐射的患者中。
Objective. In fecal incontinence the role of elastography has not yet been evaluated. We performed a trial to further characterize the internal and external anal sphincter in patients with fecal incontinence and compared a visual assessment scale with a computerized program for quantifying elastic properties of the anal sphincter. Material and methods. Fifty consecutive patients with fecal incontinence were studied (n = 31 following lower anterior resection, n = 8 with Crohn's disease, n = 9 following colon surgery, n = 2 others). Elastogram color distribution within the sphincter representing elastic properties was quantified using a visual analog scale and an off-line computerized area calculation program. Results. The main finding was that the inner anal sphincter (IAS) differed significantly from the external anal sphincter (EAS) with regard to elastogram color distribution. There were no significant correlations with clinical and functional parameters. There was, however, a non-significant increase in the percentage of blue (hard) areas in the IAS in patients neoadjuvantly irradiated for rectal or cervical cancer compared to non-irradiated patients, which was accompanied by a significant decrease in the resting sphincter pressure (p < 0.009). Conclusions. The IAS, a smooth muscle, and the EAS, a striated muscle, have different elastogram color distributions, probably reflecting their different elastic properties. The absence of significant correlations with the major clinical and functional parameters suggests that in routine clinical practice ultrasound real-time elastography may not yield additional information in patients with fecal incontinence. There may be exceptions, particularly in irradiated patients.