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Objective@#To evaluate the diagnostic value of three-dimensional endoanal ultrasound (3D-EAUS) for dyssynergic defecation (DD).@*Methods@#A case-control study was performed to retrospectively collectclinical data of 46 DD patients, including 16 males and 30 females with median age of 51 (20 to 70) years, at Nanjing Hospital of Chinese Medicine from February 2012 to April 2015.All the patients met the diagnostic criteria of functional constipation of Rome III. The paradoxical contraction of puborectalis (PR) muscle was found by both rectal examination and anorectal manometry. In the same period,45 healthy volunteers, including 22 males and 23 females with median age of 48 (21 to 72) years, without pelvic operation history, and with normal defecation in recent 6 months, were enrolled as the control group. No significant differences were observed in age and gender between two groups (both P>0.05). Cleveland constipation score of DD group was higher than that of control group [15(8-24) vs. 5(1-9), t=15.720, P<0.001]. 3D-EAUS examination was performed in all the subjects. Thickness and length of internal anal sphincter (IAS) (anterior side and posterior side), thickness of PR muscle, length of external anal sphincter (EAS) plus PR muscle, and puborectalis angle were measured and compared by using student t test between two groups. Correlation between these ultrasound parameters and anorectal manometry was examined by Pearson correlation analysis.@*Results@#Both male and female in the DD group had the greater thickness of IAS, as compared to those in the control group [male: (1.7±0.5) mm vs.(1.5±0.2) mm, t=2.516, P=0.016; female: (1.9±0.4) mm vs.(1.6±0.5) mm, t=2.034,P=0.047]. No significant differences between the two groups were observed with respect to the posterior length of IAS, length of EAS plus PR muscle, and thickness of PR muscle (all P>0.05). Compared to the control group, male in the DD group had smaller puborectalis angle during straining [(87.0±3.6)° vs. (90.5±1.8)°,t=3.502,P=0.002];female in the DD group had smaller puborectalis angle both in resting and straining [resting:(86.5±3.8)° vs. (90.1±2.1)°,t=4.047, P<0.001;straining: (84.1±4.5)° vs. (90.2±2.3)°, t=5.938, P<0.001]. Correlation analysis showed that anterior length of IAS was positively correlated with anal resting pressure (r=0.321, P=0.030); the length of EAS plus PR muscle was positively correlated with anal squeeze pressure (r=0.415, P=0.004). There were no correlations between the thickness and the posterior length of IAS and the anal resting pressure, or between the thickness of PR muscle and the anal squeeze pressure (all P>0.05).@*Conclusions@#The 3D-EAUS can accurately assess the morphological features of anal canal in DD patients. There is a certain positive correlation between 3D-EAUS and anorectal manometry.
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Objective To investigate the value of dynamic transperineal ultrasound in women with chronic proctalgia.Methods A prospective study was described.Women met the diagnostic criteria of chronic proctalgia were included.Patients were submitted to dynamic transperineal ultrasound.Bladder neck descent(BND),retrovesical angle(RVA),anorectal angle,rectocele and other indicators were observed at rest and during maximal Valsalva.Results A total of 33 patients with chronic proctalgia were included.BND was 1.1-27.5 (13.21 ± 7.77)mm,4 of which were more than 25 mm.The RVA were greater than 140 ° in 8 patients during Valsalva maneuver.Six cases were diagnosed with cystourethrocele and 5 cases were diagnosed with isolated cystocele.Anorectal angles were 82.6-134.0 (113.12 ± 10.95) ° at rest and 77.6-123.0 (110.10 ± 13.28) ° during Valsalva respectively,there was no statistical significance (P ＞ 0.05).Fourteen cases were found rectocele with the depth 1.2-1.7 (1.38 ±-0.17)cm;14 cases were found rectal intussusceptions,7 of which were associated with rectocele,2 of which were associated with rectocele and enterocele.Conclusions Dynamic transperineal ultrasound can show the whole pelvic floor anatomy in female patients with chronic proctalgia to evaluate the pelvic floor function and detect other functional disorders.
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<p><b>OBJECTIVE</b>To observe the short- and long-term efficacy of acupuncture combined with biofeedback in the treatment of functional anorectal pain (FARP).</p><p><b>METHODS</b>Clinical data of 142 patients who met the functional gastrointestinal disorders and functional anorectal pain based on criteria of Rome III( undergoing acupuncture with biofeedback therapy from August 2010 to November 2015 in Pelvic Floor Center of The Third Affiliated Hospital of Nanjing University of Chinese Medicine were retrospectively analyzed. Telephone and outpatient clinic recheck were used as standard follow-up. The clinical effect of short-term and long-term data collected from the disease-based database was evaluated with visual analogue pain scale (VAS) (0-10 points), short form health survey questionnaire (SF-36) (0-148 points). The overall satisfaction and effectiveness (VAS was >30%) were evaluated at the end of treatment (short-term) and during follow-up (long-term).</p><p><b>RESULTS</b>The effective follow-up data were obtained from 71.1%(101/142) of patients and the median follow-up time was 28(3-67) months. The VAS of 101 cases was 6.09±1.78, 1.99±1.89 and 3.55±2.60 before treatment, at the end of treatment and during follow-up respectively. Though the VAS during follow-up was higher than that at the end of treatment, but still significantly lower than that before treatment(P<0.05). The SF-36 score of 31 patients was 82.0±16.9, 94.0±15.1 and 88.1±15.3 before treatment, at the end of treatment and during follow-up respectively. Though the SF-36 score during follow-up was lower compared to at the end of treatment, but still significantly higher compared to before treatment (P<0.05). The effective rates were 85.9%(122/142) at the end of treatment and 75.2%(76/101) during follow-up, and the satisfactory rates were 92.3%(131/142) and 84.2%(85/101), respectively.</p><p><b>CONCLUSION</b>Acupuncture with biofeedback has significant short-term and long-term efficacy in treating functional anorectal pain, and its degree of satisfaction is high.</p>
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Objective To investigate the value of the three-dimensional endorectal ultrasonography (3D-ERUS) in the tumor staging before transanal endoscopic microsurgery (TEM).Methods The clinical data of 30 patients with rectal cancer who underwent 3D-ERUS before TEM at the Nanjing Hospital of Traditional Chinese Medicine from April 2012 to December 2013 were retrospectively analyzed.The accuracy,sensitivity and specificity of the 3D-ERUS were evaluated according to the results of the postoperative pathological examination.The consistency of the results of the 3D-ERUS and postoperative pathological examination were compared by Kappa consistency test.Results Of 30 patients,25 patients in stage T0,3 in stage T1 and 2 in stage T2 were diagnosed by preoperative 3D-ERUS.There were 2 patients (stage pT0) with inflammatory polyp by postoperative pathological diagnosis,6 patients (stage pT0) with tubular adenoma,16 patients (stage pT0) with villioustublar adenoma,2 patients (stage pTis) with carcinoma in situ,2 patients (stage pT1) with tectal adenoma and 2 patients (stage pT2) with rectal adenoma.There were 2 patients with excessive tumor staging by 3D-ERUS,1 patient in stage pT0 was misdiagnosed in stage T1,1 in stage pT1 was misdiagnosed in stage T2 and 1 in stage pT2 was misdiagnosed in stage T1 with insufficient tumor staging.The accuracy of 3D-ERUS in the preoperative tumors staging of TEM was 90.0％ compared with the resuls of postoperative pathological examination.The accuracy,sensitivity and specificity of 3D-ERUS in stage pT0,pTl,and pT2 of TEM were 96.7％,90.0％,93.3％ and 96.2％,50.0％,50.0％ and 100.0％,92.8％,96.4％,respectively.There was a significant difference in the consistency between preoperative 3D-ERUS and postoperative pathological examination (κ =0.685,P ＜ 0.05).Conclusion 3D-ERUS is an accurate clinical method in the preoperative tumors staging of TEM,and can be used as the preoperative assessment for TEM.
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<p><b>OBJECTIVE</b>To compare the accuracy of two-dimensional endoanal ultrasound (2D-EAUS) and three-dimensional endoanal ultrasound (3D-EAUS) in the diagnosis of perianal fistulas.</p><p><b>METHODS</b>Image data of 47 perianal fistula patients undergoing surgery in our department between January 2012 and December 2012 were collected. All the patients underwent 2D-EAUS and 3D-EAUS, and the results were compared to intraoperative findings (gold standard) by kappa concordance test.</p><p><b>RESULTS</b>Both 2D-EAUS and 3D-EAUS showed good concordance with intraoperative findings in internal opening (kappa: 0.776 vs. 0.636). 3D-EAUS had better concordance with intraoperative finding in the diagnosis of intersphincteric, high transsphincteric and suprasphincteric fistulas as compared to 2D-EAUS (kappa: 0.810 vs. 0.592, kappa: 0.863 vs. 0.548, kappa: 1.000 vs. 0.672). 3D-EAUS showed better concordance with intraoperative findings in secondary tract compared to 2D-EAUS(kappa: 0.659 vs. 0.535). Both 2D-EAUS and 3D-EAUS had good concordance with intraoperative findings in complicated abscesses (kappa: 0.881 vs. 0.816).</p><p><b>CONCLUSION</b>3D-EAUS can show the relationship of fistula with anal sphincter, especially in diagnosing high fistula and fistula with secondary tracts, and has a higher diagnostic accuracy than 2D-EAUS.</p>
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Humans , Anus Diseases , Diagnostic Imaging , Endosonography , Methods , Imaging, Three-Dimensional , Rectal Fistula , Diagnostic ImagingABSTRACT
Objective To evaluate the clinical diagnostic value of pelvic floor sEMG in pelvic floor dyssynergia (PFD) by using receiver operating characteristic curve (ROC curve). Methods The pelvic floor sEMG of 90 patients with PFD and 101normal controls were determined by the Glazer protocol.Parameters including amplitude (AVG),coefficient of variance (CV),onset time and median frequency (MF),and the ROC curve werealso investigated. Results Compared to the control group,the PFD group had a higher AVG of pre-baseline (P < 0.05), a lower AVG during Flick and Tonic steps(P < 0.05), and ahigher CV duringTonic and Endurance steps(P < 0.05).The area under curve(AUC) of CV duringthe tonic step was 0.883 withthe best cut-off of 0.355, and with sensitivity of 88.4%and the specificity of 71.1%, respectively; The AUC of CV duringEndurance step was 0.825 withthe best cut-off of 0.305, and with the sensitivity of 84.9%and the specificity of 67.8% , respectively. Conclusion The CVs of the tonic and the endrnace phases can be used as valuable clinical values in diagnosis of PFD.
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Objective To evaluate the agreement between dynamic transperineal ultrasound (DTP-US)and dynamic magnetic resonance imaging defecography (DMRD) in the diagnosis of rectocele,and to compare the correlation and difference between the depth of rectocele measured by DTP-US and DMRD.Methods The clinical data of 18 female patients with rectocele who were admitted to the Third Affiliated Hospital of Nanjing University of Chinese Medicine from September 2011 to May 2012 were retrospectively analyzed.All patients received examination via DTP-US and DMRD,and the agreement of the 2 diagnosing methods was analysed.The accurate rates of the detection of other pelvic floor abnormalities by the 2 methods were calculated.The agreement of DTP-US and DMRD in diagnosing rectocele was analysed by Cohen's kappa test.The difference of the depth of rectocele measured by DTP-US and DMRD was compared by paired samplet test,and the correlation of the depth of rectocele measured by DTP-US and DMRD was analyzed by using the Pearson correlation coefficient.Results Of the 14 patients diagnosed by DTP-US,there were 7 patients with bladder prolapse,5 with unrelaxed pelvic floor,2 with uterine prolapse,2 with rectal internal mucous intussusception and 1 with enterocele; of the 18 patients diagnosed by DMRD,there were 12 patients with bladder prolapse,8 with unrelaxed pelvic floor,8 with uterine prolapse,6 with rectal internal mucous intussusception and 1 with enterocele.The agreement coefficient between DTP-US and DMRD in diagnosing rectocele was obvious (κ =0.737,P ＜ 0.05).The depth of the rectocele detected by DTP-US and DMRD were (15 ±6)mm (range,7-24 mm) and (27 ±7)mm (range,20-41 mm),with significant difference between the 2 groups (t =-16.124,P ＜0.05).There was a high coefficient between DTP-US and DMRD in detecting the depth of rectocele (| r | =0.874,P ＜ 0.05).The depth of rectocele detected by DMRD increased as the increase of depth of rectocele detected by DTP-US (| r | =1.000,P ＜ 0.05).Conclusions The agreement between DTP-US and DMRD in diagnosing rectocele is high.The depth of rectocele measured by the 2 methods not only has statistically significance,but also exists a high degree of correlation.While DTP-US is superior to DMRD in terms of quick diagnosis and better telerance of patients.
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Objective To study the human papilloma virus(HPV) infection in lesion tissues of patients with common anus and rectal disease .Methods Gene amplification combined with gene chip technology were employed to conduct genotyping test in lesion tissue of 566 patients with common anus and rectal disease .Results In lesion tissues of 566 patients with common anus and rectal disease ,the overall HPV infection rate was 32 .86% (186/566) .In male patients ,the overall HPV infection rate ,monopole infection rate and multiple infection rate were 32 .14% (117/364) ,23 .35% (85/364) and 8 .79% (32/364) ,respectively ,which showed no sta-tistically significant difference with female [34 .16% (69/202) ,24 .75% (50/202) and 9 .41% (19/202) ,respectively ] (P>0 .05) . HPV 18 ,16 ,33 ,31 types were the main types of common anus and rectal disease .Conclusion HPV genotyping test of anus and rectum tissues is important for molecular epidemiological studies of HPV infection in anus and rectum .