RU2268647C2 - Method for diagnosing rectum functioning disorder cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves marking two points mapping distal coccyx and symphysis part positions. Ruler is applied to the points over the imaginary coccygeosymphyseal line between the points on skin. 10 cm long metal rod of 1.9 mm diameter having ticks from 1cm to 3 cm is introduced into anal canal. Anococcygeal angle is measured between the ruler and the metal rod. One angle side is segment binding a point belonging to distal coccyx part projection to anal canal axis and the other side is the continuation of this axis above anodermal surface. The coccygeal angle magnitude being greater than 90°, rectum obturation apparatus disorder is to be diagnosed.

EFFECT: high accuracy of early stage diagnosis.

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Description

The invention relates to surgery, namely to coloproctology.

The external and internal sphincter, the pubic-rectal muscle perform the function of anal retention and are the locking apparatus of the rectum. The pubo-rectal muscle covers the rectum in the form of a sling, forms an anorectal angle, thereby participating in the holding of intestinal contents. Methods for diagnosing diseases associated with the work of the suborethal muscle are complex, expensive and can be performed in a hospital on x-ray machines. Therefore, the development of minimally invasive outpatient, inexpensive methods for diagnosing the work of the rectum is relevant.

As an analog, the authors propose a method of sphincterometry, which is performed using a spring sphincterometer and allows you to study the function of the anal pulp at rest, with straining and arbitrary compression of the anus. Sphincterometry is performed as follows: an ovoid is introduced into the rectum. The steelyard is attached to the rod. The force of retention of the ovoid by the anal pulp at rest and volitional force is measured. (A.M. Aminev. Textbook on proctology. Moscow. 1977, p. 12-13).

The disadvantages of the analogue include:

1. The specified method does not allow to isolate the strength of the pubic-rectal muscle from the sum of the muscle strength of the anal pulp at rest, with straining and arbitrary compression of the anus.

2. It is not possible to judge the degree of involvement of the puborectal muscle in the work of the obturator apparatus of the rectum.

As a prototype, the authors propose a method for determining the anorectal angle, which reflects the work and dysfunctions of the pubic-rectal muscle. Anorectal angle is formed in the transition zone of the rectal ampoule into the anal canal. The wall of the rectum in this area passes in the pelvic floor, and due to the pull of the pubic-rectal muscle, the axis of the anal canal goes to the navel. Anorectal angle is determined using proctography. The rectum is filled with barium using an enema. Proctography is performed in lateral projection. Two conventional lines are applied to the radiological image - the axis of the rectal ampoule and the axis of the anal canal. An anorectal angle is formed, which is normally 90 degrees. An increase in the anorectal angle leads to the coincidence of the axes of the rectal ampoule and the anal canal and its holding disorders (Rivkin V.L. Bronstein A.S., Fain S.N. Guide to Coloproctology. Medical practice. 2001, p. 101).

The disadvantage of the prototype is:

1. The only method for measuring anorectal angle is proctography.

2. Proctography is a laborious and expensive method that requires an X-ray unit, consumables for it, and specially trained personnel.

3. When conducting proctogaphia, a radiation load on the patient takes place, which creates the possibility of a negative impact on the patient’s health status and limits the scope of the method.

The authors propose a method for diagnosing the operation of the obturator of the rectum by measuring the ano-coccygeal angle.

The essence of the method is as follows: two points are located on the skin located in the projection of the distal parts of the coccyx and symphysis.

Overlaying the ruler corresponds to an imaginary line between these points on the skin. Another conditional line is a continuation of the axis of the anal canal above the surface of the anoderm, which is determined by introducing into the anal canal to a depth of 3 cm a metal rod 10 cm long, 1.9 mm in diameter, with divisions from 1 to 3 cm. It is proposed to measure the angle formed between the ruler and a metal rod, one side of which is a segment from the point located in the projection of the distal section of the coccyx to the axis of the anal canal, and the other is the continuation of this axis above the surface of the anoderm, and call this angle ano-coccygeal.

The essence of the method of studying the obturator function of the rectum is illustrated in the drawing. Two points are located on the skin located in the projection of the distal parts of the coccyx (1) and symphysis (2). The imposition of the ruler corresponds to an imaginary line between these points on the skin (3). Another conditional line is a continuation of the axis of the anal canal above the surface of the anoderm (4), which is determined by introducing into the anal canal to a depth of 3 cm a metal rod 10 cm long, 1.9 mm in diameter, with divisions from 1 to 3 cm (5). Ano-coccygeal angle (6) is measured between the ruler and the rod.

Using a method for diagnosing rectal dysfunction by measuring ano-coccygeal angle, the authors examined 28 patients with normal obstructive rectal function. This angle ranged from 60 to 86 degrees. 30 people were examined with clinical signs of a violation of the obturator apparatus of the rectum: its incontinence, rupture of the perineum, resection of the rectum with incontinence, hemorrhoids. On average, the external ano-coccygeal angle in this group of patients was more than 90 degrees.

Clinical example. The patient is 28 years old. Was admitted to the hospital with rupture of the perineum and incontinence of the rectum. The patient performed proctography. An anorectal angle increase of up to 100 degrees was revealed. The patient measured ano-coccygeal angle, which amounted to 106 degrees.

New in comparison with the prototype is:

1. To study the functions of the rectum, the measurement is not of the anorectal angle, but of the ano-coccygeal angle.

2. Measurement of ano-coccygeal - coccygeal angle can be performed without proctography, which allows you to remove radiation exposure to the patient.

3. The proposed study can be performed on an outpatient basis and reduce the cost of the study.

Claims (1)

A method for diagnosing rectal dysfunction, characterized in that two points are marked on the skin opposite the distal sections of the coccyx and symphysis, a ruler corresponding to an imaginary line between these points on the skin is marked on the indicated points, a metal rod with a length of 3 cm is inserted into the anal canal 10 cm, 1.9 mm in diameter, with divisions from 1 cm to 3 cm, measure the ano-coccygeal angle between the ruler and the metal rod, one side of which is a segment from a point located distally in the projection Division of the coccyx, the anus to the axis, and the other - the continuation of the axis above the surface anodermy, a value ano-kochikovogo angle greater than 90 ° diagnose disorders state closing apparatus rectum.