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20
Õ°ðU¤†ïL^
No. 9
2009. 2
Fig. 1 Normal picture of
Endoanal linear echo
( posterior ) . Conjoined
longitudinal muscle (LM)
is described by high echo
between
the
internal
sphincter muscle (IAS)
and the external sphincter
muscle (EAS). There is a
line described by low echo
in the center, which we
named as the low echoic
line.
Fig. 3 A. sagit­
tal view (poste­
rior), B. coronal
view (lateral).
The
conjoined
longitudinal mus­
cle was disco­
vered to be de­
veloped on the
back as seen on
the
ultrasound
picture.
å“ØÆðíÁĢȢæ¤É`o³êé±ÆÆCg
DwIŸ¢ÉæèCA‡c–ت½ŠØÈçÑɋ‡
gDüÛÅ\¬³êÄ¢é±Æðl¦éÆC°Çcw
ØÉüÛªÆèÜ¢Ä\¬³êÄ¢éÆl¦é̪Ã
–Ævíê½DܽA‡c–ØÌà”É smooth mus­
cle bundle ƵĽŠØª¶Ý·éÆÌLÚàÝç
ê4) C»Ì bundle ª´¹gŸ¸É¨¯é Low echoic
Fig. 2 Normal picture of Transcutaneous linear echo
(posterior). Low echoic line is developed better on the back
than on the side and line is extending toward the coccyx.
line ƵÄ`o³êéÌÅÍÈ¢©Æl¦çê½D¤
‘ Ì´ ¹g Ÿ¸ ÅÍ Û^ CÜ ^Í ±Ì Low echoic
line Ìà¤É èCÝ^CÞ^ÍO¤É`o³êé½
–ØÍ Masson's trichrome õFÉÄüÛÌLxÈ\
ßC^ffðs¤ÛñíÉdvÈ line Æl¦çê½D
¢¨Å Á½DܽR¡äØRÌõFÉÄõF³ê
¶ £
1) ₃êҘD2007DÀnãÆ̽ßÌèå¾³fÃv‰N
eBXCiä‘XCåãCpp95_124
2) ÷zKjC‚쳎Cªcõ¶Ù©D1972D¤‘̪ÞDú
184
{å°èåaï 25: 177_
3) Bartram CI, Frudinger A. 1997. Handbook of Anal En­
dosonography, Wrightson Biomedical Pub, Petersˆeld UK,
Bristol PA, pp21_41
4) Gordon PH, Nivatvongs S. 1992. Principles and Practice of Sur­
gery for the Colon, Rectum, and Anus, Quality Medical Pub, St
Louis, pp1_37
¸CR½ŠØRÌõFÉÄõF³ê½DA‡c–ØÍ
ñíÉüÛÌLxÈgDƽŠØÅ\¬³êÄ¢½D
l
@
A‡c–ØÍC°ÇcwØÆèå“تðíÁÄ\
¬³êÄ¢éÆLÚ³êĢ鶣ª è3) CÇÌæ
¤È\¢¨Å é©Ü¾s¾ÄÅ éD¡ñÌíêí
ê̟¢ÅÍC´¹gŸ¸É¨¢ÄA‡c–تàè
å‡ñØÆÀ–µ°ÇcwØÉA±µÄ¢½Dܽè
Local dissection for ultrasound diagnosis of anal ˆstula: mainly conjoined longitudinal muscle
1Tokatsu
Yasuo NAKAJIMA1, Yasunobu TSUJINAKA1, Kumiko YAMAGUCHI2, Keiichi AKITA2
Tsujinaka Hospital, 2Unit of Clinical Anatomy,Graduate School, Tokyo Medical and Dental University
We conduct manual and ultrasound examination for anal ˆstula diagnosis. Ultrasound examination is important to diagnose the depth
of the anal ˆstula. In particular, the conjoined longitudinal muscle is used as an indicator to diagnose the depth of the anal ˆstula. For
ultrasound examination, we use three types of probes: Endoanal radial probe, Endoanal linear probe and Transcutaneous linear probe.
Conjoined longitudinal muscle is described by high echo in ultrasound examination. There is a line delineated or revealed by low echo
in the center, which we termed the low echoic line. In order to conˆrm whether low echoic lines described by each probe are identical,
we conducted 3D ultrasound examination and ultrasound examination using intermuscular abscess as an indicator.
By such investigations, we conˆrmed that the low echoic line in each ultrasound picture is identical. Low echoic lines are developed
better on the back than on the side and lines extend toward the coccyx. We made a longitudinal sample of the anal surrounding area
from the back and the side to conduct an anatomical investigation. In this investigation, the conjoined longitudinal muscle was disco­
vered to be developed on the back as seen on the ultrasound picture. Histological investigation helped us discover that the conjoined
longitudinal muscle consists of abundant ˆbers and smooth muscles.
Key words: conjoined longitudinal muscle, anal ˆstula, ultrasound examination, anal local dissection
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21

2) ヨーロッパにおけるレーザ微細加工に関する研究開発動向調査報告