Method for diagnosing the cases of anterior rectocele

FIELD: medicine.

SUBSTANCE: method involves carrying out visual and rectal examination. Peripheral blood circulation speed is measured in rectovaginal partition blood vessels. Rectovaginal partition folds are detected and increase in its thickness. Levators separation exceeding 20 mm is determined. Fibrous degeneration of rectovaginal partition is detected. Reduced blood circulation speed in levators is detected. Anterior rectocele is diagnosed. Values are measured by introducing ultrasonic transducer into the rectum. One of versions assumes introduction of hygienic intravaginal tampon into the vagina.

EFFECT: high reliability of diagnosis.

2 cl, 8 dwg

 

The invention relates to medicine, in particular to proctology, and can be used to determine the disease with combined pathology of the rectovaginal septum in women - rectocele.

A known method for the diagnosis of anterior rectocele women by visual examination, rectal examination and chiropractory, while in the rectum injected contrast agent and during defecation produce the film, which record the change in the switching apparatus of the rectum, with an increase compared to normal anorectal angle diagnose the disease (see Physiology of defecation in the book. Coloproctology and the pelvic floor muscles./ Ed. by M. Henry, M. Swosu. - M.: Medicine, 1998, s).

The disadvantage of this method is its great length, complexity and the need for special equipment Cabinet with expensive equipment and qualified service personnel.

There is also known a method for the diagnosis of anterior rectocele in women with comorbidity rectovaginal septum by visual and rectal examinations, metrics and comparing them with the provisions of this measure indicators of sphincter tone at rest and in a state of willful compression of the rectum through the introduction in her anal electrode, by means of which determine the state of the sphincter of the rectum (see Dultsev J.V., Salamov KN. Anal incontinence, chap 2. Research methods locking apparatus of the rectum. - M.: Medicine, 1993, s.43-51).

The disadvantage is that the known method is only defined by stage of disease, sphincter of the rectum, and the conclusion of stage rectocele make on the basis of visual and rectal examinations, which is a subjective factor, significantly reducing the reliability of the diagnosis.

The closest in technical essence and the achieved effect and selected as a prototype is a method of diagnosis of anterior rectocele women by visual and rectal examinations, measurement inside the rectovaginal septum, which consists in measuring the peripheral speed of blood flow in the vessels ( RF patent No. 2154975 from 17.06.1999 year).

This study is carried out using laser flametree apparatus "Transonic Systems". Measure rate of peripheral blood vessels in the inside and rectovaginal septum. Moreover, the measurements of blood flow inside the rectovaginal septum is produced by introducing a needle probe into the vagina. Then make a comparison with the norm diagnose and stage the disease. By reducing the flow velocity in comparison with the rate of 25-30% on Instituut stage II disease, 35-40% of stage III of the disease, more than 40% of stage IV disease.

The disadvantage is that this study allows us to examine the state of the peripheral bloodflow and indirectly by reducing it to judge the severity of degenerative changes. While it is impossible to study the state of the components rectovaginal septum and their relationship. In addition, the introduction of a needle probe into the vagina is not a very safe method of research.

The purpose of this invention is to provide a method for enhancing the reliability of the diagnosis of anterior rectocele women.

The technical result of the invention is to provide objective data to study the components of rectovaginal septum: the thickness of the rectovaginal septum, the distance between lavatori, the status of the blood supply to levatores, the degree of degenerative changes rectovaginal septum.

Method for the diagnosis of anterior rectocele women by visual and rectal examinations, measurement inside the rectovaginal septum, which consists in measuring the peripheral speed of blood flow in blood vessels, according to the invention, in addition to measuring the speed of blood flow, get the image right and left levatores, measure the distance between them and determine the thickness of the rectovaginal septum, spend discografia components comprising the rectovaginal septum, and the measurements carried out by means of the ultrasonic sensor by entering it into the rectum.

Method for the diagnosis of anterior rectocele women by visual and rectal examinations, measurement inside the rectovaginal septum, which consists in measuring the peripheral speed of blood flow in blood vessels, according to the invention, in addition to measuring the speed of blood flow, get the image right and left levatores, measure the distance between them and the thickness of the rectovaginal septum, are discografia components comprising the rectovaginal septum, and the measurements carried out by means of the ultrasonic sensor by entering it into the rectum and additional vaginal insertion vnutrivlagalishnogo hygienic swab type "Tatry".

The use of endorectal ultrasound (endorectal ultrasonography) has great advantages compared with the use of laser research, which allows to determine both the speed of the flow, which allows you to indirectly judge the degree of degenerative changes. Widely used in endorectal ultrasound found a linear rect the local sensor various modifications, which allows to study the structure papadimitrou, pozavcherashnego and rectovaginal space. Endorectal ultrasound study allows you to visually determine the status and relationship of the components of the rectovaginal septum, histography components rectovaginal septum, reflecting the average amplitude of reflection of ultrasonic waves from levatores, and to determine the rate of blood flow through dopplerography. These figures are compared with the indicators that determine the rate, and then draws conclusions about the state of the rectovaginal septum and subsequent treatment.

Often ultrasound interpretation components of the rectovaginal septum is more difficult as the density of its structures in some cases the same. In this case, use the insertion into the vagina vnutrivlagalischnye hygienic swab type "Tampax", with which it is possible to solve the problem: to define more clearly the boundaries of the rectal wall and the vagina to examine the histogram components of the rectovaginal septum, to determine the rate of blood flow.

The proposed diagnostic method is safe and can be used as a screening.

The above options have a single inventive concept and solve one problem by improving diagnosis rates across the Avani rectovaginal septum.

The above distinguishing features are new in comparison with the prototype, therefore, the invention conforms to the criterion "novelty".

Patent research has shown that in the investigated prior art do not have the same technical solution, i.e. the claimed technical solution is not clear from the investigated prior art and thus meets the criterion of "inventive step".

This diagnostic method can be widely used for diagnosis of diseases of the rectovaginal septum in women using ultrasonic sensors, therefore, it meets the criterion of "industrial applicability".

The invention is illustrated more materials, in which figure 1 presents ultrasonogram rectovaginal septum women (20 years); figure 2 - ultrasonogram rectovaginal septum women without clinical manifestations rectocele (30 years); figure 3 - ultrasonogram rectovaginal septum women with symptomatic rectocele (35 years); 4 - ultrasonogram rectovaginal septum women with symptomatic rectocele (51); figure 5 - histogram structures rectovaginal septum (and - women 20 years, b - women without clinical manifestations rectocele 30 years, in women with clincheck the mi manifestations of rectocele 35, d - women with symptomatic rectocele 51); 6-dopplergram rectovaginal septum (and - women 20 years, b - women without clinical manifestations rectocele 30 years, in women with symptomatic rectocele 51); 7 - ultrasonogram rectovaginal septum women with clinical manifestation of rectocele using tampon "Tampax"; Fig - dopplerogramma patient 54 years old with clinical manifestation of rectocele 3rd degree (a - before the operation, b - after the operation).

Rectocele is the protrusion of the anterior wall of the rectum into the vagina - is one of the common causes of disorders of defecation in women. Studies have shown that the rectovaginal septum is formed collagen fibers, fibrous tissue and smooth muscle fibers. Striated muscle fibers included in the rectovaginal septum (fiber muscles, levator anus), maintain the rectum, involved in the formation of the rear wall of the birth canal. A very important role for the muscles that raise the anus (levator) in the act of defecation. The reason rectocele is the discrepancy of the front portions of levatores, the weakening of the muscular frame and fabric rectovaginal septum due to injury, inflammation, increasing intra-abdominal pressure, the cash is Chiyo innate deep Douglasawh space.

Main diagnostic criteria of rectocele with endorectal ultrasonography following:

1) folding rectovaginal septum and the increase of its thickness;

2) the divergence of levatores more than 20 mm;

3) fibrous degeneration of the rectovaginal septum;

4) a significant reduction of blood flow velocity in levator that allows to distinguish two categories of patients: patients with a trunk type of flow and patients with resistive type of blood flow.

Studies were conducted on the apparatus SonoAce 8800 using a microconvex probe in the frequency range from 4 to 9 MHz with the use of color Doppler mapping mode energy of the reflected Doppler signal (EODS). To this end endorectal ultrasound (ultrasonography) held at 11 nulliparous women (group I); 5 parous women without clinical manifestations rectocele (group II) and 23 symptomatic rectocele (group III).

Research methodology is the following: after cleansing enema the patient is placed on the left side. The emitter of the sensor is put on the condom, which is covered with a special gel. The sensor is inserted into the lumen of the rectum. By changing the angle microconvex sensor get the image right and left levator, measure the distance between nimii assess the structural features of the rectovaginal septum, spend discografia components comprising the rectovaginal septum, and Doppler determining blood velocity.

Analysis of images obtained from the research showed that in group I the thickness of the rectovaginal septum 1,10±0,13 cm (figure 1), in group II - 1,60±0.10 cm (figure 2) and III - 1,74±0,12 cm (Fig 3, 4). Research levatores showed that in group I of their thickness to 21.91±0.81mm (figure 1), in group II the thickness 26,00±2.40 mm (figure 2), III - 26,67±3,80 mm (Fig 3, 4, where a is the thickness of rectovaginal perevozki, b is the distance between lavatori). Comparing these figures with the norm, diagnose the degree of change rectovaginal septum.

According to the histograms of the components of the rectovaginal septum, the average amplitude of reflection of ultrasonic waves from levatores in group I was 67,55±1.57 gradations of gray scale figa), in the II - 69,00±20,41 gradations of gray scale figb), III - 74,33±19,23 gradations of gray scale FIGU, 5g).

Endorectal ultrasound is transversely located microconvex sensor and shows that the rectovaginal septum in women of group I and II represents tendinosus structure, which gradually passes into the right and left lavatory - the average amplitude of reflection of ultrasonic waves 96,50±1.38 hail the third gray scale (Fig. 5A, 5B). Whereas in group III patients have a replacement rectovaginal septum dense fibrous tissue, a measure of the average amplitude of reflection of ultrasonic waves 83,89±22,65 gradations of gray scale), the distance between lavatori increases to 26,33±a 3.87 mm (FIGU, 5g).

The study of blood flow (Doppler) in the field of rectovaginal septum is also carried out using the proposed ultrasonic sensor using certain modes required to obtain dopplergram. This Doppler studies showed that in the first two groups is the main type of flow, peak systolic blood flow velocity (PSS) are in the range 26,69±2.36 cm/s, whereas in group III there is a trend towards a significant decrease in PSS - range 9,88±0.8 cm/s (FIGU), and the flow was acquired traits resistive.

Doppler scanning rectovaginal septum is of great importance for predicting the postoperative period. The analysis of the direct and immediate results of surgical treatment of patients showed that patients with a trunk type of flow of levatores postoperative period runs favorably and evacuation function of the rectum is restored in the early (up to 2 weeks time after surgery. And in patients with resistive type of flow of levatores (figa), despite the high quality standard, postoperative rehabilitation is carried out within 3-6 months, that is, in this period of time, patients should regularly use laxatives, less enema. Control Doppler studies of the rectovaginal septum (figb) show a gradual improvement of blood supply of levatores that is determined by the velocity of the blood flow.

At the same time, despite the high information content of the known methods for the study of ultrasonic interpretation of the components of the rectovaginal septum is sometimes difficult, because the density of its structures in some cases the same.

In this case, the proposed improvement of this technique by applying marker. Used for this purpose is vnutrivlagalischnye hygienic swab type "Tampax"significantly different in density from the surrounding tissues. Endorectal ultrasound with contrast vaginal hygiene swab possible to clearly determine the boundaries of the rectal wall and the vagina, the localization of levatores, to study the histogram components of the rectovaginal septum, to spend Doppler to determine the flow velocity (Fig.7).

When is that if the analysis ultrasonogram confirms the increasing thickness of the rectovaginal septum, its folding, it talks about reducing its upregulations properties. In this case, the use of the tampon "Tampax" allows you to more accurately diagnose changes in the rectovaginal septum.

Thus, endorectal ultrasound histogram structures rectovaginal septum, Doppler examination, which determines the type of blood flow in the diagnosis of rectocele is an important diagnostic event. The use of a tampon "Tampax" increases the reliability of this diagnostic method.

Example No. 1. Patient F. 47 years have complained of constipation (stool 1 time in 3-4 days after taking laxatives or enemas), feeling of incomplete emptying of the bowel. When finger rectal examination showed a significant polarisavenue rectovaginal septum. When endorectal ultrasonography thickness of the rectovaginal septum - 19 mm, type of flow of levatores - resistance with speed reduction to 11-12 cm/s, the distance between elevatori - 21 mm Diagnosis: anterior rectocele III degree. Operated front of levatorplasty. The patient was discharged on day 7. At follow-up pelvic floor muscles correctly formed, chair 1 time in 2 days after receiving Rast is positive laxatives. Normalized stool after 5 months after surgery. Recovery.

Example No. 2. Patient C. 35 years have complained of constipation (stool 1 time in 3-4 days after taking laxatives or enemas), feeling of incomplete emptying of the bowel. When finger rectal examination showed a significant polarisavenue rectovaginal septum. When endorectal ultrasonography thickness of the rectovaginal septum - 19 mm, type of flow of levatores - trunk with a speed of 60 cm/s, the distance between elevatori - 30 mm Diagnosis: anterior rectocele III degree. Operated front of levatorplasty. Independent chair without the use of laxatives for 3 days after surgery, and thereafter daily, simultaneously. The patient was discharged on day 7. At follow-up pelvic floor muscles correctly formed stools daily without the use of laxatives. Recovery.

1. Method for the diagnosis of anterior rectocele women by visual and rectal examination, measurement of the speed of the peripheral blood vessels in the rectovaginal septum, characterized in that when detecting folding rectovaginal septum and the increase of its thickness, the divergence of levatores more than 20 mm, fibrous degeneration of the rectovaginal septum, reduce the drop of blood flow velocity in levator diagnose anterior rectocele, when this measure is implemented by the introduction of the ultrasonic probe in the rectum.

2. Method for the diagnosis of anterior rectocele women by visual and rectal examination, measurement of the speed of the peripheral blood vessels in the rectovaginal septum, characterized in that when detecting folding rectovaginal septum and the increase of its thickness, the divergence of levatores more than 20 mm, fibrous degeneration of the rectovaginal septum, the reduction of blood flow velocity in levator diagnose anterior rectocele, and the measure shall be implemented by the introduction of the ultrasonic probe in the rectum and additional vaginal insertion vnutrivlagalishnogo hygienic swab type "Tampax".



 

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