Zusammenfassung
Die anorektale Endosonographie ist bei verschiedenen Erkrankungen von Anus, Rektum
und Beckenboden einsetzbar. Vergleichbar mit der Rektoskopie oder Proktoskopie ist
die Endosonographie ein einfach durchzuführendes und valides Diagnostikum ohne wesentliche
Patientenbelastung. Primär wurde die anorektale Endosonographie für das Tumorstaging
evaluiert, jedoch nur kurze Zeit später wurde die Bedeutung dieses Untersuchungsverfahrens
für gutartige anorektale Erkrankungen evident. Die Muskulatur des Analsphinkters kann
klar dargestellt werden, der innere und der äußere Schließmuskel kann unterschieden
werden. Weitere Beckenbodenstrukturen, wie die Puborektalisschlinge, der Levatormuskel
und die Organe des kleinen Beckens lassen sich visualisieren. Eine besondere Bedeutung
hat die Endosonographie in der Sphinkterdiagnostik, insbesondere in der Diagnostik
von Sphinkterdefekten und in der postoperativen Kontrolle nach Schließmuskelrekonstruktion.
Ein weiteres endosonographisches Indikationsfeld sind perianale Abszesse oder Analfisteln.
Lokale Schmerzen oder Stenosen limitieren gelegentlich diese Untersuchungsmethode.
Die anorektale Endosonographie stellt ein kostengünstiges, rasch verfügbares Diagnostikum
für alle Arten anorektaler Erkrankungen dar. Ausbildung, Standardisierung und Qualitätskontrolle
sind wichtig und bedürfen einer weiteren Evaluation.
Abstract
Anorectal endosonography may be used for diagnosing various disorders of the anus,
rectum and pelvic floor. Similar to rectoscopy or proctoscopy anal endosonography
is easy to perform and discomfort for the patient is low. Anorectal endosonography
was first described in tumor staging, but short time later the value of endosonographic
imaging became evident in benign anorectal disorders. Anal sphincter can be clearly
visualized and distinction is possible between external and internal anal sphincter.
Other pelvic structures can be visualized like M. levator or the puborectalis muscle.
Endosonography is important in diagnosing sphincter pathologies, in localizing sphincter
defects and controlling the result of sphincter repair. In anorectal or perineal sepsis,
endosonography is a useful tool in defining localization of an abscess or a fistula
tract. Limitations of endosonography are local pain or stenosis. Conclusion: Anal endosonography is a non expensive and useful diagnostic procedure for benign
anorectal disorders. Teaching, training, standard investigation procedure and quality
control in endosonography are important and require further evaluation.
Schlüsselwörter
Anale Endosonographie - Analsphinkter - Inkontinenz - Analfistel - Analabszess
Key words
Anal endosonography - Anal sphincter - Anal incontinence - Perianal fistula - Perianal
abscess
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Dr. med. Alois Fürst
Klinik für Chirurgie, Universitätsklinik
93042 Regensburg
Telefon: 0941/944-0
Fax: 0941/944-6802
eMail: alois.fuerst@klinik.uni-regensburg.de
