CAJ | 학술논문

目的通过肛门直肠畸形术后排粪失禁患儿的盆腔MRI表现,了解盆底肌的形态,直肠、肛管的形态和位置,以及脊髓和骶骨的发育,为分析排粪失禁的原因及制订治疗方案提供客观依据.方法回顾性分析2009年9月至2011年12月间山东大学第二医院收治的34例肛门直肠畸形术后排粪失禁患儿的临床和影像资料,其中男21例,女13例,年龄3～14岁.应用1.5T MR扫描仪,常规行轴位、冠状位及矢状位扫描,观察肛门括约肌、耻骨直肠肌和提肛肌、直肠、肛管的形态,以及脊髓、骶骨的发育情况.结果 MRI检查提示:肛门外括约肌发育不良18例,耻骨直肠肌发育不良23例,肛提肌发育不良27例；直肠位置异常6例,直肠扩张12例,肛直角增大11例;肛管周围脂肪组织5例；合并神经管闭合不全2例,Currarino综合征2例,骶骨发育不全11例,直肠尿道瘘2例.以上影像学结果均经临床最终证实.结论 MRI可清楚显示肛门外括约肌、耻骨直肠肌和肛提肌的形态,以及直肠和肛管的形态和位置,同时还可显示脊髓和骶骨的发育情况,是评价肛门直肠畸形术后排粪失禁患儿非常有价值的检查方法.
목적 통과항문직장기형술후배분실금환인적분강MRI표현,료해분저기적형태,직장、항관적형태화위치,이급척수화저골적발육,위분석배분실금적원인급제정치료방안제공객관의거.방법 회고성분석2009년9월지2011년12월간산동대학제이의원수치적34례항문직장기형술후배분실금환인적림상화영상자료,기중남21례,녀13례,년령3～14세.응용1.5T MR소묘의,상규행축위、관상위급시상위소묘,관찰항문괄약기、치골직장기화제항기、직장、항관적형태,이급척수、저골적발육정황.결과 MRI검사제시:항문외괄약기발육불량18례,치골직장기발육불량23례,항제기발육불량27례；직장위치이상6례,직장확장12례,항직각증대11례;항관주위지방조직5례；합병신경관폐합불전2례,Currarino종합정2례,저골발육불전11례,직장뇨도루2례.이상영상학결과균경림상최종증실.결론 MRI가청초현시항문외괄약기、치골직장기화항제기적형태,이급직장화항관적형태화위치,동시환가현시척수화저골적발육정황,시평개항문직장기형술후배분실금환인비상유개치적검사방법.
Objective To study the development of pelvic floor muscle,morphology and location of rectum and anal canal as well as morphology of spinal cord and sacrum based on pelvic magnetic resonance imaging (MRI) of children with fecal incontinence after anoplasty for anorectal malformation and to provide information on management of fecal incontinence.Methods Clinical and MRI data of 34 children with fecal incontinence after anoplasty for anorectal malformation in the Second Hospital of Shangdong University from September 2009 to December 2011 were analyzed retrospectively.There were 21 males and 13 females with the age of 3 to 14 years old.All the children underwent MRI detection.The morphology of external anal sphincter,puborectalis,ani levator,rectum and anal canal as well as the development of spinal cord and sacrum were observed using 1.5T MR scanner,including routine axial view,coronal view and sagittal view.Results MRI revealed that dysplasia of external anal sphincter,puborectalis and anilavatory were found in 18,23 and 27children,respectively.MRI also showed ectopia of rectum (n=6),dilation of rectum (n=12),increased anorectal angle(n=1 1),fat tissue around the anal canal(n=5),tethered cord syndrome(n=2),Currarino syndrome(n=2),sacrum dysplasia(n=11); and rectourethral fistula(n=2).The above MRI findings were confirmed by operation and clinical practice.Conclusions MRI can provide clear morphology of external anal sphincter,puborectalis and ani lavatory,and location of rectum and anal canal as well as the development of spinal cord and sacrum.MRI is a valuable method to evaluate the children with fecal incontinence after anoplasty.