Mahony Rhona, Behan Michael, O'Herlihy Colm, O'Connell P Ronan
Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Dis Colon Rectum. 2004 Jan;47(1):12-7. doi: 10.1007/s10350-003-0009-6. Epub 2004 Jan 14.
Third-degree tears are generally managed by primary anal sphincter repair. Postoperatively, some physicians recommend laxative use, whereas others favor bowel confinement after anorectal reconstructive surgery. This randomized trial was designed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair.
A total of 105 females were randomized after primary repair of a third-degree tear to receive lactulose (laxative group) or codeine phosphate (constipated group) for three days postoperatively. Patients were reviewed at three days and at three months postpartum. Recorded outcome measures were symptomatic and functional outcome and early postoperative morbidity.
Forty-nine patients were randomly assigned to the constipated group and 56 patients to the laxative group. The first postoperative bowel motion occurred at a median of four (mean, 4.5 (range, 1-9)) days in the constipated group and at two (mean, 2.5 (range, 1-7)) days in the laxative group (P<0.001). Patients in the constipated group had a significantly more painful first evacuation compared with the laxative group (P<0.001). The mean duration of hospital stay was 3.7 (range, 2-6) days in the constipated group and 3.05 days in the laxative group (range, 2-5; P=0.001). Nine patients in the constipated group complained of troublesome postoperative constipation compared with three in the laxative group (P=0.033). Continence scores, anal manometry, and endoanal ultrasound findings were similar in the two groups at three months postpartum.
Patients in the laxative group had a significantly earlier and less painful bowel motion and earlier postnatal discharge. There was no difference in the symptomatic or functional outcome of repair between the two regimens.
三度撕裂伤通常通过一期肛门括约肌修复术进行处理。术后，一些医生建议使用泻药，而另一些医生则倾向于在肛门直肠重建手术后限制排便。本随机试验旨在比较一期产科肛门括约肌修复术后早期管理中泻药方案与便秘方案的效果。
105名女性在三度撕裂伤一期修复后被随机分组，术后三天分别接受乳果糖（泻药组）或磷酸可待因（便秘组）治疗。在产后三天和三个月时对患者进行复查。记录的结果指标包括症状和功能结果以及术后早期发病率。
49名患者被随机分配到便秘组，56名患者被分配到泻药组。便秘组术后首次排便的中位时间为4天（平均4.5天，范围1 - 9天），泻药组为2天（平均2.5天，范围1 - 7天）（P<0.001）。与泻药组相比，便秘组患者首次排便时疼痛明显更剧烈（P<0.001）。便秘组的平均住院时间为3.7天（范围2 - 6天），泻药组为3.05天（范围2 - 5天；P = 0.001）。便秘组有9名患者抱怨术后便秘困扰，而泻药组为3名（P = 0.033）。产后三个月时，两组的控便评分、肛门测压和肛管超声检查结果相似。
泻药组患者排便时间明显更早、疼痛更轻，产后出院更早。两种方案在修复的症状或功能结果方面没有差异。
