Schlömer Gabriele, Gross Mechthild, Meyer Gabriele
Universität Hamburg, FB 13, IGTW-Gesundheit, Martin-Luther-King-Platz 6, D-20146 Hamburg, Deutschland.
Wien Med Wochenschr. 2003;153(11-12):269-75. doi: 10.1046/j.1563-258x.2003.02023.x.
Episiotomy is the most common surgical intervention in the world. In Europe the rate of episiotomy is approximately 30% (23). Reasons for this intervention are the reduction of risk for tears and incontinence. To assess the effects of restricted episiotomy in the prevention of urinary and faecal incontinence. Medline search for 1990-7/2002, Cochrane Library (Issue 2, 2002), GEROLIT and SOMED and the Internet. RCTs analysing restrictive or non-restrictive episiotomy were included if they had comprehensive randomisation, follow-up and exclusion of selection bias. Cohort studies were assessed to evaluate the risk of developing faecal incontinence. If possible, data were pooled. Included were all pregnant women with vaginal delivery. Intervention/exposition: Restrictive vs. liberal episiotomy (median, lateral or mediolateral). Incontinence rate (urine and stool) 3 months and 3 years post partum. All included randomised controlled studies met the criteria above, one randomised controlled study used blinded assessment of outcome parameter. Lots of follow-up was 33% (after 3 years). Cohort studies partly were retrospective. 2 randomised controlled studies measuring urinary incontinence were included. The rate for episiotomy was 60% in the intervention group with liberal episiotomy and 27% in the restricted group. No difference could be found in groups measuring urinary incontinence (RR 0.98, 95% CI 0.83-1.20). Only two included cohort studies measured the effect of episiotomy on faecal incontinence. The chance of developing faecal incontinence in association with episiotomy was more than threefold (OR = 3.64, 95% CI 2.15-6.14). Restrictive episiotomy neither effects the development of urinary incontinence of post partum women (RR 0.98 95%, CI 0.83-1.20) three months and three years after vaginal delivery, nor the risk for trauma. Women without episiotomy suffer significantly less from faecal incontinence (OR = 3.6). Further investigation is required to measure the effect of no intervention versus liberal episiotomy.
会阴切开术是世界上最常见的外科手术干预措施。在欧洲，会阴切开术的实施率约为30%（23）。进行这种手术干预的原因是降低撕裂和大小便失禁的风险。为评估限制会阴切开术在预防尿失禁和大便失禁方面的效果。检索了1990年至2002年7月的医学文献数据库（Medline）、Cochrane图书馆（2002年第2期）、GEROLIT和SOMED以及互联网。纳入了分析限制性或非限制性会阴切开术的随机对照试验（RCT），前提是这些试验具有全面的随机化、随访且排除了选择偏倚。对队列研究进行评估以评估发生大便失禁的风险。如有可能，对数据进行汇总。纳入的对象为所有经阴道分娩的孕妇。干预/暴露因素：限制性会阴切开术与宽松性会阴切开术（正中、侧切或中侧切）。产后3个月和3年时的失禁率（尿液和粪便）。所有纳入的随机对照研究均符合上述标准，一项随机对照研究对结局参数采用了盲法评估。大量随访率为33%（3年后）。队列研究部分为回顾性研究。纳入了2项测量尿失禁的随机对照研究。在宽松性会阴切开术的干预组中，会阴切开术的实施率为60%，在限制性组中为27%。在测量尿失禁的组中未发现差异（相对危险度RR = 0.98，95%可信区间CI为0.83 - 1.20）。仅两项纳入的队列研究测量了会阴切开术对大便失禁的影响。与会阴切开术相关的发生大便失禁的几率增加了三倍多（比值比OR = 3.64，95%可信区间CI为2.15 - 6.14）。限制性会阴切开术既不影响产后妇女在阴道分娩后3个月和3年时尿失禁的发生（RR = 0.98，95%CI为0.83 - 1.20），也不影响创伤风险。未进行会阴切开术的女性大便失禁的发生率显著更低（OR = 3.6）。需要进一步研究来测量不进行干预与宽松性会阴切开术的效果。
