Sydney Medical School Nepean, Penrith, NSW, Australia.
Acta Obstet Gynecol Scand. 2012 Feb;91(2):211-4. doi: 10.1111/j.1600-0412.2011.01315.x. Epub 2012 Jan 9.
To study whether avulsion and ballooning are independent risk factors for symptoms and/or signs of pelvic organ prolapse.
Retrospective analysis of data obtained in clinical practice.
Tertiary urogynecology unit.
Seven hundred and sixty-one consecutive women with symptoms of pelvic floor dysfunction.
Evaluation included history, vaginal examination and four-dimensional translabial ultrasound. Ultrasound analysis was performed off-line, blinded against clinical data. Hiatal dimensions were measured at the plane of minimal hiatal dimensions. Puborectalis avulsion was identified using tomographic imaging.
Symptoms and objective signs of prolapse (ICS POP-Q stage 2+).
Owing to previous surgery 156 women were excluded, leaving 605, of whom 258 (43%) had prolapse symptoms. Significant prolapse (International Continence Society Prolapse Quantification System grade 2+) was identified as follows: cystocele in 222 (37%) women, rectocele in 159 (27%) and apical in 40 (8%), while 110 (18%) had an avulsion. There was a strong association between avulsion, hiatal ballooning and symptoms/signs of prolapse (p < 0.001). On multivariable backwards stepwise logistic regression, puborectalis avulsion was associated with an increased risk of symptoms and signs of prolapse, even after allowing for the degree of levator ballooning. The presence of avulsion did not modify the relation between hiatal area and symptoms of prolapse.
Puborectalis avulsion injury and levator hiatal ballooning are independent risk factors for symptoms and signs of prolapse. The role of avulsion in the pathogenesis of prolapse is not fully explained by its effect on hiatal dimensions. It is likely that avulsion implies not only muscular trauma but also damage to structures impossible to assess clinically or by imaging, i.e. myofascial and connective tissue.
研究是否撕脱和气球样膨出是盆腔器官脱垂症状和/或体征的独立危险因素。
临床实践中获得的数据的回顾性分析。
三级泌尿妇科单位。
761 例有盆底功能障碍症状的连续女性。
评估包括病史、阴道检查和四维经阴道超声。超声分析在离线进行，与临床数据盲法对照。在最小裂孔尺寸平面测量裂孔尺寸。使用断层成像识别耻骨直肠肌撕脱。
脱垂的症状和客观体征（国际尿控协会脱垂定量系统 2+期）。
由于先前的手术，156 名女性被排除在外，留下 605 名女性，其中 258 名（43%）有脱垂症状。明显的脱垂（国际尿控协会脱垂定量系统 2+期）如下：222 名女性（37%）有膀胱膨出，159 名女性（27%）有直肠膨出，40 名女性（8%）有顶端膨出，而 110 名女性（18%）有撕脱。耻骨直肠肌撕脱、裂孔气球样膨出与脱垂的症状/体征之间存在很强的关联（p<0.001）。在多变量逐步向后逻辑回归中，耻骨直肠肌撕脱与脱垂的症状和体征的风险增加相关，即使在允许提肌气球样膨出程度的情况下也是如此。撕脱的存在并没有改变裂孔面积与脱垂症状之间的关系。
耻骨直肠肌撕脱伤和提肌裂孔气球样膨出是脱垂症状和体征的独立危险因素。撕脱在脱垂发病机制中的作用不能仅通过其对裂孔尺寸的影响来解释。撕脱不仅可能导致肌肉创伤，还可能导致无法通过临床或影像学评估的结构损伤，即肌筋膜和结缔组织损伤。
