Zusammenfassung.
Ziel: In dieser Arbeit wird die Wertigkeit des endoanalen Ultraschalls (EUS) in der präoperativen
Abklärung der fäkalen Inkontinenz (FI) im Vergleich zur Manometrie unter Berücksichtigung
der Operationsbefunde analysiert. Die Anamnese, die Lokalisation der Sphinkterdefekte
und die angewandten Therapiemodalitäten wurden untersucht. Methoden: In einem Zeitraum von 3 Jahren wurden 92 Patienten mit FI mittels EUS untersucht.
81 Patienten erhielten zusätzlich eine Manometrie des Analkanals. Ergebnisse: 27 Patienten (29 %) zeigten im EUS keinen Defekt, 18 (20 %) einen isolierten Defekt
im Musculus sphincter ani internus, 13 (14 %) einen isolierten Defekt im Musculus
sphincter ani externus und 34 (37 %) einen kombinierten Defekt. Gynäkologische/geburtshilfliche
Ursachen waren am häufigsten (54 %). Der EUS korrelierte mit den Operationsbefunden
in 100 % (n = 13), die Manometrie lediglich in 54 %. Die Manometriebefunde korrelierten
mit dem EUS in 30 %. Schlussfolgerung: Der EUS ist eine sehr sensitive Methode zur exakten Lokalisationsdiagnostik von Schließmuskeldefekten
und ist daher essentiell bei der Abklärung einer fäkalen Inkontinenz.
Value of endoanal sonography in the assessment of faecal incontinence.
Purpose: The aim of this study was to assess the value of endoanal ultrasound (EUS) in comparison
to anal manometry and operative findings in patients suffering from faecal incontinence.
Patient history, localisation of sphincter defects and therapeutic modalities were
analysed. Methods: Over a 3-years period, 92 patients with faecal incontinence were investigated by
endoanal ultrasound. Results were compared with anal manometry in 81 cases. Results: At EUS, 27 patients (29 %) showed no sphincter defect, 18 (20 %) had an isolated
internal sphincter defect, 13 (14 %) an isolated defect of the external sphincter
and 34 (37 %) presented with a combined internal/external sphincter defect. Manometry
correlated in 30 % with endoanal ultrasound. Compared with surgery, endoanal ultrasound
was correct in 100 % and manometry in only 54 %. An obstetric trauma was most frequently
related to faecal incontinence. Conclusion: Endoanal ultrasound is a very sensitive method for localizing anal sphincter defects
and is mandatory in the assessment of patients with faecal incontinence.
Schlüsselwörter:
Fäkale Inkontinenz - Endoanaler Ultraschall - Sphinktermuskulatur - Sphinkterdefekt
Key words:
Faecal incontinence - Endoanal ultrasound - Anal sphincter - Sphincter defect
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Dr. Andrea Maier
Universitätsklinik für Radiodiagnostik, Wien
Währinger Gürtel 18-20,
1090 Wien
Österreich
Telefon: +43 1 40400 4819
Fax: +43 1 40400 4898
eMail: andrea.maier@univie.ac.at
