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골반 출구 폐쇄증 환자에서 관찰된 배변조영술 소견의 연구

Investigation of Defecographic Findings in Patients with Pelvic Outlet Obstructive Disease

대한대장항문학회지 2005년 21권 6호 p.376 ~ 383
김경래 ( Kim Kyung-Rae ) - 건국대학교 의과대학 외과학교실

김영석 ( Kim Young-Sok ) - 건국대학교 의과대학 외과학교실
정순섭 ( Chung Soon-Sup ) - 이화여자대학교 의과대학 외과학교실
안은정 ( Ahn Eun-Jung ) - 이화여자대학교 의과대학 외과학교실
오수연 ( Oh Soo-Yoon ) - 건국대학교 의과대학 외과학교실
박웅채 ( Park Ung-Chae ) - 건국대학교 의과대학 외과학교실
손대호 ( Son Dae-Ho ) - 영남대학교 의과대학 외과학교실
사공준 ( Sakong Joon ) - 건국대학교 의과대학 산업의학교실
김상운 ( Kim Sang-Woon ) - 영남대학교 의과대학 외과학교실
김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실

Abstract


Purpose: Defecography is a dynamic investigation which can influence clinical decision making in patients with pelvic outlet obstructive disease (POOD). The current study was designed to establish defecographic findings in patients with POOD. Specifically, we sought to assess the physiologic characteristics of categorized types by using anorectal physiologic tests.

Methods: One hundred seven patients (disease group; 45 men, 62 women) with POOD were retrospectively categorized as type I [non-relaxation of puborectalis (NRPR) only, n=19], type II [NRPR and rectocele, n=20], type III [NRPR, rectocele, and dynamic perineal descent (PD), n=17], type IV [deformed rectocele, mild-to-moderate fixed PD, and absence of NRPR, n=29], and type V [rectocele, severe fixed PD, and absence of NRPR, n=20] on the bases of defecographic findings. The ability to evacuate, the frequency/degree of intarectal intussusception (IRI), and the size of the rectocele were evaulated in these defecographic types of POOD. Age, duration of symptoms, and the physiologic findings of anal manometry and EMG/PNTML were compared for the five types. Eighteen healthy volunteers who had no defecation difficulty were used to estimate the normal findings of defecography.

Results: The age and the sex showed no significant differences among the types. The duration of symptoms was gradually lengthened from type I to V (P<0.01). The ability to evacuate in patients with POOD was significantly worse (failed to effectively evacuate) compared to that in the healthy volunteers (P<0.01). The frequency of IRI was increased more and more from type I to V (P<0.01). The size of the rectocele was significantly increased in types V compared to the other types (P<0.01). Manometric and neurologic findings, including EMG/PNTML, revealed no significant differences among the types.

Conclusions: Even though there were no specific differences in the findings of the anal manometric and neurologic tests, the evacuation dynamics; were different in the five defecographic categories of patients with POOD. Specifically, these differences were relevants to the presence of NRPR, rectoceles, IRI, and perineal descent. J Korean Soc Coloproctol 2005; 21:376-383

키워드

배변조영술;비이완성 치골직장근;직장류;회음하강;골반출구 폐쇄증
Defecography;Nonrelaxing puborectalis;Rectocele;Perineal descent;Pelvic outlet obstructive disease
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