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Anorektale Diagnostik bei proktologischen Erkrankungen

Anorectal diagnostics for proctological diseases

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Zusammenfassung

Durch eine strukturierte Anamnese, die Erfassung von Konsensuskriterien und die klinische Untersuchung lässt sich die überwiegende Zahl proktologischer Erkrankungen diagnostizieren. Zur weiterführenden Diagnostik von Analfisteln sind Endosonographie und Magnetresonanztomographie (MRT) gleichwertige Verfahren. Die MRT bietet Vorteile bei der Darstellung von komplexen Fisteln und Rezidivfisteln. Anorektale Funktionsstörungen sind multifaktoriell und mit Veränderungen im Bereich der Beckenbodenkompartimente vergesellschaftet. Bei der Beckenbodendiagnostik nimmt die MR-Defäkographie eine zentrale Stellung ein. Andere funktionelle diagnostische Methoden und neurophysiologische Untersuchungen treten wegen fehlender Standards und hoher physiologischer Variabilität in den Hintergrund. Zur Objektivierung der vielschichtigen Symptomenkomplexe und der Lebensqualität ist die subjektive Einschätzung des Patienten anhand von Scores notwendig. Problematisch sind die Vielzahl, die unterschiedliche Güte und fehlende Standards bei der Anwendung von Scores. Die Zusammenführung der bildmorphologischen Untersuchungsbefunde mit der in Scores erfassten subjektiven Wahrnehmung ist Voraussetzung für eine Optimierung der Diagnostik und Therapiebewertung in der Proktologie.

Abstract

The majority of proctological diseases can be defined by a structured evaluation of the symptoms and a physical examination. Magnetic resonance imaging (MRI) and anal endosonography can detect complex anal fistulas with a high accuracy but MRI should be preferred because of its objective visualization. Functional anorectal disorders are multifactorial and show morphological and functional irregularities in different compartments of the pelvic floor which is why MR defecography is now one of the most important methods in diagnostic algorithms. Interpreting the results of anal endosonography, anal manometry and neurophysiological testing is highly demanding because of large interindividual variability. Scores are used for objective measurement of symptom severity and quality of life. In clinical practice, well validated scores evaluated in large patient groups with predetermined circumstances are needed. Bringing together morphological results with scores based on subjective perception is required to optimize diagnostics and therapy evaluation in proctology.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland

    T. Jackisch, H. Witzigmann & S. Stelzner

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Jackisch, T., Witzigmann, H. & Stelzner, S. Anorektale Diagnostik bei proktologischen Erkrankungen. Chirurg 83, 1023–1032 (2012). https://doi.org/10.1007/s00104-012-2296-8

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