Kammerer-Doak D N, Wesol A B, Rogers R G, Dominguez C E, Dorin M H
Department of Obstetrics and Gynecology, University of New Mexico Hospital Health Sciences Center 87131, USA.
Am J Obstet Gynecol. 1999 Dec;181(6):1317-22; discussion 1322-3. doi: 10.1016/s0002-9378(99)70370-4.
This study was undertaken to prospectively assess subjective anorectal symptoms by questionnaire and to prospectively assess the integrity of the anal sphincter by physical and ultrasonographic examination in women with and without obstetric anal sphincter laceration.
Fifteen subjects who sustained obstetric anal sphincter lacerations at the time of vaginal delivery were matched with 15 control subjects and followed up prospectively. Women underwent physical and ultrasonographic evaluations and answered questionnaires regarding anorectal symptoms at 6 weeks and at 4 months post partum. Data were evaluated with the Fisher exact test, the Wilcoxon exact and signed rank tests, and the McNemar test.
On postpartum examination the subjects with lacerations had more separated sphincters and decreased anal resting and squeeze tones with respect to control subjects (P <.05). According to ultrasonographic evaluation the anal sphincters were more commonly disrupted in the laceration group than in the control group (external anal sphincter, 40% vs 20%; P =.43; and internal anal sphincter, 47% vs 7%; P =.035). Subjective rating of fecal incontinence was significantly greater in the laceration group than in the control group (P <.05). There was no correlation between fecal incontinence symptoms and the integrity of the external anal sphincter. At the 4-month visit, fecal incontinence was resolved in 36% of subjects; however, continued anorectal dysfunction was reported by 43% of subjects in the laceration group versus only 7% of the control subjects (P =.08).
Reports of fecal incontinence were significantly greater among women with a history of primarily repaired obstetric anal sphincter lacerations than among control subjects. Ultrasonographic examination revealed separated anal sphincters in 40% of the women with obstetric anal sphincter lacerations, despite repair at the time of delivery.
本研究旨在通过问卷调查前瞻性评估主观肛门直肠症状，并通过体格检查和超声检查前瞻性评估有或无产科肛门括约肌裂伤的女性肛门括约肌的完整性。
15名在阴道分娩时发生产科肛门括约肌裂伤的受试者与15名对照受试者进行匹配，并进行前瞻性随访。女性在产后6周和4个月接受体格和超声评估，并回答有关肛门直肠症状的问卷。数据采用Fisher精确检验、Wilcoxon精确检验和符号秩检验以及McNemar检验进行评估。
产后检查发现，与对照受试者相比，有裂伤的受试者括约肌分离更多，肛门静息和收缩张力降低（P<.05）。根据超声评估，裂伤组肛门括约肌中断的情况比对照组更常见（肛门外括约肌，40%对20%；P=.43；肛门内括约肌，47%对7%；P=.035）。裂伤组大便失禁的主观评分明显高于对照组（P<.05）。大便失禁症状与肛门外括约肌的完整性之间没有相关性。在4个月的随访中，36%的受试者大便失禁得到缓解；然而，裂伤组43%的受试者报告持续存在肛门直肠功能障碍，而对照组仅为7%（P=.08）。
有主要修复过的产科肛门括约肌裂伤病史的女性中，大便失禁的报告明显多于对照受试者。超声检查显示，40%有产科肛门括约肌裂伤的女性肛门括约肌分离，尽管在分娩时进行了修复。
