Burrows Lara J, Sewell Catherine, Leffler Kenneth S, Cundiff Geoffrey W
PGY-6 Department of Gynecology and Obstetrics, Magee Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213-3180, USA.
Int Urogynecol J Pelvic Floor Dysfunct. 2003 Aug;14(3):160-3; discussion 163. doi: 10.1007/s00192-002-1019-y. Epub 2003 Jul 5.
We retrospectively reviewed 106 cases of defect-directed rectocele repair. Preoperative standardized evaluation of rectovaginal septum support was performed. Support defects were identified at surgery by visually identifying breaks in the rectovaginal fascia. Clinical and surgical findings were compared using the chi2 test. Logistic regression analysis was used to identify predictive variables. Clinical examination concurred with surgical findings in 59.4% (63/106) and differed in 40.6% (43/106). Predictors of agreement between clinical examination and intraoperative findings were the presence of multiple defects in the rectovaginal fascia at surgery (OR 4.42, 95% CI 1.89, 10.35) and stage II or III prolapse (OR 0.0007, 95% CI 0.00059, 0.003 and 0.0003, 95% CI 0.00033, 0.0017, respectively). The sensitivity and positive predictive value for all defects was less than 40%. The inaccuracy of clinical examination emphasizes the need to develop new clinical and/or imaging methods to evaluate posterior vaginal support defects.
我们回顾性分析了106例针对直肠膨出的修复手术病例。术前对直肠阴道隔支撑进行了标准化评估。手术中通过肉眼识别直肠阴道筋膜的破损来确定支撑缺陷。使用卡方检验比较临床和手术结果。采用逻辑回归分析来确定预测变量。临床检查与手术结果相符的比例为59.4%（63/106），不符的比例为40.6%（43/106）。临床检查与术中发现相符的预测因素包括手术时直肠阴道筋膜存在多个缺陷（比值比4.42，95%置信区间1.89，10.35）以及Ⅱ期或Ⅲ期脱垂（比值比分别为0.0007，95%置信区间0.00059，0.003和0.0003，95%置信区间0.00033，0.0017）。所有缺陷的敏感性和阳性预测值均低于40%。临床检查的不准确性强调了开发新的临床和/或影像学方法来评估阴道后壁支撑缺陷的必要性。
