Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
Colorectal Dis. 1999 Sep;1(5):263-6. doi: 10.1046/j.1463-1318.1999.00083.x.
The repair of sphincter injuries following vaginal delivery is often inadequate. The purpose of this study was to assess the short-term impact of involving a colorectal team in the management of patients with complicated acute severe third-degree tears.
Over a 1-year period, four women (age 29-31 years) with acute severe third-degree tears extending into the anal canal or rectum were referred to the colorectal unit for repair of the injury. The internal anal sphincter (IAS) was identified and imbricated. A nerve stimulator was used to help identify the external anal sphincter (EAS) which was repaired using an overlapping technique. The women were reassessed at 3 months with anal manometry, pudendal nerve latencies and anal ultrasound. Further clinical assessment was performed at 1 year.
Anal ultrasound revealed intact EAS repairs in all four women, although the IAS was thinned anteriorly in two. Resting anal pressures were slightly low (range 40-56 cmH2 O) but satisfactory squeeze pressures were obtained in all four women (range 78-100 cmH2 O). Pudendal nerve latencies were normal in three and prolonged on one side in the fourth woman. At 1 year, three were continent to solids, liquids and flatus, incontinence score=0, but one had occasional urgency. The fourth experienced occasional liquid seepage and frequent incontinence to flatus likely to represent IAS dysfunction (incontinence score=7).
Satisfactory short-term results may be achieved following repair of acute severe third-degree tears and a nerve stimulator is important in identifying viable EAS to be used in repair. An integrated approach involving the experience of the colorectal team and anorectal physiology permits planning of future deliveries and may improve the long-term outcome.
阴道分娩后肛门括约肌损伤的修复往往不够完善。本研究旨在评估将肛肠团队纳入管理复杂急性重度三度撕裂患者的短期影响。
在一年的时间里，有 4 名（年龄 29-31 岁）患有急性严重三度撕裂延伸至肛门或直肠的妇女被转介到肛肠科修复损伤。识别和交错内肛门括约肌（IAS）。使用神经刺激器帮助识别外肛门括约肌（EAS），并用重叠技术修复。在 3 个月时对女性进行肛门测压、阴部神经潜伏期和肛门超声检查重新评估。在 1 年时进行进一步的临床评估。
在所有 4 名女性中，肛门超声显示 EAS 修复完整，尽管有 2 名女性的 IAS 前部变薄。静息肛门压力略低（范围 40-56cmH2O），但所有 4 名女性均获得满意的挤压压力（范围 78-100cmH2O）。在 3 名女性中阴部神经潜伏期正常，而在第 4 名女性中一侧延长。在 1 年时，3 名女性对固体、液体和气体均有节制，失禁评分=0，但 1 名女性偶尔有急迫感。第 4 名女性偶尔会有液体渗漏，经常会有气体失禁，可能代表 IAS 功能障碍（失禁评分=7）。
急性严重三度撕裂修复后可能获得满意的短期效果，神经刺激器对于识别可行的 EAS 用于修复非常重要。涉及肛肠团队和肛肠生理学经验的综合方法可规划未来分娩，并可能改善长期结果。
