폐쇄성 배변장애 질환에서 배변조영술 및 배변영화 촬영술 소견의 특성과 임상적 응용 가치
Characteristic Findings and Their Clinical Appraisal of Proctography and Cinedefecography in Patients with Pelvic Outlet Obstructive Disease
김경래, 김영석, 정순섭, 이창희, 채기봉, 노혜린, 최원진, 박웅채,
소속 상세정보
김경래 ( Kim Kyung-Rae )
건국대학교 의과대학 외과학교실
김영석 ( Kim Young-Sok )
건국대학교 의과대학 외과학교실
정순섭 ( Chung Soon-Sup )
건국대학교 의과대학 외과학교실
이창희 ( Lee Chang-Hee )
건국대학교 의과대학 방사선과학교실
채기봉 ( Chae Gi-Bong )
강원대학교 의과대학 외과학교실
노혜린 ( Roh Hye-Rin )
강원대학교 의과대학 외과학교실
최원진 ( Choi Won-Jin )
강원대학교 의과대학 외과학교실
박웅채 ( Park Ung-Chae )
건국대학교 의과대학 외과학교실
KMID : 0356720030190020094
Abstract
Purpose: We were assessed the characteristic findings of defecography and cinedefecography in patients with pelvic outlet obstructive disease, and compared the characteristic physiologic findings between proctography and cinedefecography.
Methods: Physiologic findings of 196 patients who were performed at least two items of physiologic tests were retrospectively evaluated. Patients were categorized as rectocele (Group I: n=119), nonrelaxing puborectalis syndrome (Group II: n=58), rectoanal intussusception (Group III: n=16), significant sigmoidocele (Group IV: n=3). The proctographic and cinedefecographic features were analyzed according to disease categories. The sensitivity, specificity, accuracy, false positive rate, false negative rate, diagnostic rate, and reproducibility were calculated, and we analyzed the difference between proctography and cinedefecography according to the disease groups.
Results: On the proctographic examinations; 1) 112 patients were confirmed as a clinically significant rectocele (n=128, sensitivity; 94%, specificity; 79%, accuracy; 88%, false positive rate; 21%, false negative rate; 6%, kappa; 0.749). 2) A clinically significant nonrelaxing puborectalis were 36 patients (n=73, sensitivity; 62%, specificity; 73%, accuracy; 70%, false positive rate; 27%, false negative rate; 38%, kappa; 0.328). 3) 12 patients were confirmed as significant rectoanal intussusception (n=31, sensitivity; 75%, specificity; 89%, accuracy; 88%, false positive rate; 11%, false negative rate; 25%, kappa; 0.425). 4) 3 patients were confirmed as clinically significant sigmoidocele (n=15, sensitivity; 100%, specificity; 94%, accuracy; 94%, false positive rate; 6%, false negative rate; 0%, kappa; 0.316). On the combination of proctography and cinedefecography; 1) 117 patients were confirmed as a clinically significant rectocele (n=122, sensitivity; 98%, specificity; 94%, accuracy; 96%, false positive rate; 6%, false negative rate; 2%, kappa; 0.925). 2) A clinically significant nonrelaxing puborectalis were 50 patients (n=64, sensitivity; 86%, specificity; 90%, accuracy; 88%, false positive rate; 10%, false negative rate; 14%, kappa; 0.738). 3) 16 patients were confirmed as significant rectoanal intussusception (n=22, sensitivity; 100%, specificity; 97%, accuracy; 97%, false positive rate; 3%, false negative rate; 0%, kappa; 0.826). 4) 3 patients were confirmed as clinically significant sigmoidocele (n=9, sensitivity; 100%, specificity; 97%, accuracy; 97%, false positive rate; 3%, false negative rate; 0%, kappa; 0.488). As compared with combined study (proctography plus cinedefecography), the proctography show decreased diagnostic rates in the evaluation of rectocele (P < 0.05), nonrelaxing puborectalis (P < 0.01), and rectoanal intussusception (P < 0.05). And, the proctography also show increased false positive rate in the evaluation of rectocele (P < 0.01), nonrelaxing puborectalis (P < 0.01), and rectoanal intussusception (P < 0.05).
Conclusion: In our study, proctography showed a tendency to overdiagnosis. Therefore, the combined study of proctography and cinedefecography should be taken as a diagnostic tools for pelvic outlet obstructive disease. Adhering to these findings, other anorectal physiologic studies should be added for the clinically significant diagnosis.
키워드
배변조영술;배변영화 촬영술;골반출구 폐쇄증
Proctography;Cinedefecography;Pelvic outlet obstructive disease
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