| 摘要 |
FIELD: medicine.SUBSTANCE: unprepared patient lying on his/her back has his/her colon examined by ultrasonic transabdominal scanning in two perpendicular projections - longitudinal and lateral. Haustra are used as visualisation marks; their intensity is determined; a thickness of an intestinal wall, its muscular and mucosal layers is measured. Aganglionic regions, if any, are examined to assessed their state and to measure their length. A diameter of the rectal ampulla is measured. That is followed by transperitoneal examination of an anarectal region in the patient placed on his/her left side with bent knees. A sensor is placed into a rectal fossa and displaced from a pubis to a sacral bone in the course of scanning in two projections - longitudinal and longitudinally oblique with the sacral bone, symphysis, and anal canal taken as the visualisation marks. The state of a distal portion of the rectal ampulla is assessed. Aganglionic regions, if any, are examined to assessed their state and to measure their length; a thickness of internal and external anal sphincters, as well as an anorectal angle are measured. On the transition line of the rectal ampulla into the anal canal, the sensor is placed in a longitudinally oblique projection; a branch of a puborectalis loop is localised; its thickness is measured; rest echogenicity and structure are assessed. That is followed by Valsalva's manoeuvre combined with determining anorectal angle variations. The measured values are compared to the normal criteria. If the area from the colon to aganglionic regions has variations: its wall thickness of more than 2.5 mm, its muscular layer thickness of more than 0.7 mm, while the mucous layer thickness of more than 1 mm, unpronounced haustra, enlarged diameter of the rectal ampulla of more than 30 mm, the absence of the muscular layer and aganglionic differentiation, increased echogeniciety, as well as the presence of anorectal variations: decreased thickness of the external and internal sphincters of the anal canal of less than 2.5 mm, increased thickness of the puborectalis loop of more than 4.9 mm and increased echogenicity, increased rest anorectal angle of more than 100 degrees not varying at Valsalva's manoeuvre testify to the presence of hypotrophic muscular layer of the proximal layer of the colon, puborectalis loop and pelvic floor muscles dysfunction, hypoplastic sphincters, and Hirschsprung disease is diagnosed.EFFECT: method enables increasing the examination accuracy and objectivity by using the informative, evidence-based quantitative and qualitative diagnostic criteria.2 ex |
