Zusammenfassung
Fragestellung und Hintergrund:
Stuhlinkontinenz ist eine verbreitete und krankhafte Störung, oftmals verbunden mit einer Funktionsstörung des analen Sphinkters. Eine dreidimensionale (3-D) endoanale Hochfrequenzsonographie (EAUS) ermöglicht eine größere räumliche Auflösung und longitudinale Beurteilung des Analkanals als die konventionelle zweidimensionale (2-D) Untersuchung. Notwendig für Vergleichsuntersuchungen sind verlässliche Normalwerte, die Alter und Geschlecht berücksichtigen.
Patienten und Methodik:
Eine Gruppe von 30 gesunden männlichen (n = 12) und weiblichen (n = 18) Freiwilligen (medianes Alter 49 Jahre; 31–63 Jahre) unterzog sich einer 3-D-EAUS mit einem Hochfrequenz-10-MHz-Schallkopf. Ein Datenzylinder wurde rekonstruiert, um eine Messung der Analkanalstrukturen in 2-D auf proximaler, mittlerer und distaler Analkanalhöhe und in 3-D für longitudinale Messungen vorzunehmen.
Ergebnisse:
Die Männer hatten einen signifikant längeren 3-D-externen analen Sphinkter (EAS) und internen analen Sphinkter (IAS) als die Frauen, insbesondere im anterioren Anteil des EAS (Mittel bei Männern 2,5 cm, Mittel bei Frauen 1,6 cm; p < 0,0001). Bei der Analkanallänge oder beim 2-D-Scanning der Dicke des EAS und des IAS gab es keine signifikanten Unterschiede zwischen den Geschlechtern. Es fanden sich auch keine signifikanten Unterschiede zwischen Frauen mit und ohne Entbindungen. Das Alter hatte keine signifikante Auswirkung auf die 3-D-Längenmessungen, die 2-D-EAUS-Messungen der Dicke von IAS und EAS nahmen jedoch mit dem Alter signifikant zu (Analkanalmitte; p = 0,004). Auf den Grundlagen dieser Daten wurden Normalwerte generiert.
Schlussfolgerung:
Die Sphinktermessungen mittels 3-D-Rekonstruktion unterscheiden sich je nach Alter und Geschlecht. Für einen künftigen Datenvergleich in verschiedenen Erkrankungsstadien wurden Normalwerte errechnet, die diese Unterschiede mit einbeziehen.
Abstract
Purpose:
Faecal incontinence is a common and morbid disorder that is often related to anal sphincter dysfunction. High-frequency, three-dimensional (3-D) endoanal ultrasonography (EAUS) allows greater spatial resolution and longitudinal appreciation of the anal canal than conventional 2-D assessment. A robust normal range of values allowing for age and sex is required for subsequent disease comparison.
Methods:
A group of 30 healthy male (n = 12) and female (n = 18) volunteers (median age, 49 years; range, 31–63 years) underwent 3-D EAUS using a high-frequency 10-MHz transducer. A reconstructed data cube was interrogated to measure anal canal structures in 2-D at high, middle and low levels, and in 3-D for longitudinal measurements.
Results:
Men had a significantly longer 3-D external anal sphincter (EAS) and internal anal sphincter (IAS) than women, especially the anterior EAS (mean in men 2.5 cm, mean in women 1.6 cm, p < 0.0001). There were no significant differences between the sexes for anal canal length or by 2-D scanning for the thickness of the EAS and IAS. No significant differences were observed between parous and nulliparous women. Age had no significant effect on 3-D length measurements, but 2-D EAUS measurements of the thickness of both the IAS and EAS increased with age significantly (mid canal, p = 0.004). On these bases, normal ranges were generated.
Conclusion:
Sphincter measurements, enabled by 3-D reconstruction, vary with age and sex. A normal range incorporating these variations has been produced for future data comparison in disease states.
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Übersetzter Nachdruck aus Tech Coloproctocol 2008;12:323–9; DOI 10.1007/s10151-008-0443-5
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Knowles, A., Knowles, C., Scott, S. et al. Einfluss von Alter und Geschlecht auf die dreidimensionale endoanale Sonographie: Entwicklung von Normalwerten. Coloproctol 31, 161–168 (2009). https://doi.org/10.1007/s00053-009-0017-7
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DOI: https://doi.org/10.1007/s00053-009-0017-7