Abstract：
Levator ani deficiency has been implicated in anterior pelvic floor pathology but its association with pelvic floor defaecatory dysfunction is less clear. The aim was to examine the relationship of levator ani deficiency with anatomical abnormalities (rectocoele, intussusception, enterocoele, perineal descent) and patient symptoms (bowel, vagina) in patients with pelvic floor defaecatory dysfunction.
The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]).
The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]).
The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.
摘要：
目的：前盆底病变与肛提缺乏有关，但其与盆底排便功能障碍的关系尚不清楚。目的是检查肛提肌缺乏与解剖异常的关系（直肠，肠套叠,肠镜,会阴下降)和患者症状(肠，阴道）盆底排便功能障碍患者。
方法：前瞻性观察性病例系列的223名女性出现在三级结直肠盆底单元排便功能障碍。每个人都接受了症状严重程度和生活质量（QoL）评分的评估，综合全盆底超声（PFUS）（经阴道，经会阴）和排便直肠造影（DP）。Rectocoele,肠套叠,对两者均进行了肠膨出和会阴下降评估。采用阴道内超声对提拔肛门缺乏症进行评分（评分0-18；轻度[0-6]，中等[>6-12]，严重的[>12-18])。
结果：直肠肿瘤患者的比例，肠镜,和肠套叠随着提肛肌损伤的增加而增加(轻度，中度,严重)。直肠肌的大小与肛提肌缺乏之间存在弱正相关。在PFUS上,肠套叠的严重程度与肠系膜和肛提肌缺乏之间存在弱正相关。在DP上，会阴下降与提肛肌缺乏之间存在弱正相关。肠道症状和QoL评分与肛提提肌缺乏之间没有关联。阴道症状与提肛肌缺乏有关。
结论：与盆底排便功能障碍有关的解剖异常（直肠，肠套叠,肠镜,会阴下降）与肛提提肌缺乏症恶化有关。肠道症状与肛提提肌缺乏之间没有关联。阴道症状与提肛肌缺乏有关。
方法：前瞻性观察性病例系列的223名女性出现在三级结直肠盆底单元排便功能障碍。每个人都接受了症状严重程度和生活质量（QoL）评分的评估，综合全盆底超声（PFUS）（经阴道，经会阴）和排便直肠造影（DP）。Rectocoele,肠套叠,对两者均进行了肠膨出和会阴下降评估。采用阴道内超声对提拔肛门缺乏症进行评分（评分0-18；轻度[0-6]，中等[>6-12]，严重的[>12-18])。
结果：直肠肿瘤患者的比例，肠镜,和肠套叠随着提肛肌损伤的增加而增加(轻度，中度,严重)。直肠肌的大小与肛提肌缺乏之间存在弱正相关。在PFUS上,肠套叠的严重程度与肠系膜和肛提肌缺乏之间存在弱正相关。在DP上，会阴下降与提肛肌缺乏之间存在弱正相关。肠道症状和QoL评分与肛提提肌缺乏之间没有关联。阴道症状与提肛肌缺乏有关。
结论：与盆底排便功能障碍有关的解剖异常（直肠，肠套叠,肠镜,会阴下降）与肛提提肌缺乏症恶化有关。肠道症状与肛提提肌缺乏之间没有关联。阴道症状与提肛肌缺乏有关。
