Karbanova Jaroslava, Rusavy Zdenek, Betincova Lucie, Jansova Magdalena, Parizek Antonin, Kalis Vladimir
Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
European Centre of Excellence NTIS - New Technologies for Information Society, Faculty of Applied Sciences, University of West Bohemia, Czech Republic.
Int J Gynaecol Obstet. 2014 Jan;124(1):72-6. doi: 10.1016/j.ijgo.2013.07.011. Epub 2013 Sep 25.
To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy.
In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1-2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair.
MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P=0.6) or vaginal (8.5% vs 10.6%, P=0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P=0.7). MLE was associated with shorter repair times (P<0.05), less suturing material (P<0.05), and shorter distances from the anus (P<0.001).
Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.
评估初产妇行会阴侧切术和侧方会阴切开术后阴道及会阴创伤的发生率和程度。
在捷克共和国皮尔森大学医院进行的一项前瞻性随机研究中，2010年4月至2012年4月连续纳入790例初产妇。会阴侧切术（MLE）与中线呈至少60°角。侧方会阴切开术（LE）从中线外侧1 - 2 cm处开始，朝向坐骨结节。在会阴切开术修复前进行直肠检查。
390例妇女行会阴侧切术，400例妇女行侧方会阴切开术。两组在产妇或新生儿特征方面无差异。在阴道及会阴创伤的发生率或程度方面未发现差异；沿会阴切开术切口继续的额外会阴创伤（1.8%对1.5%，P = 0.6）或阴道创伤（8.5%对10.6%，P = 0.2）也无差异。会阴侧切术和侧方会阴切开术之间肛门括约肌损伤的发生率无差异（1.5%对1.3%，P = 0.7）。会阴侧切术与较短的修复时间（P < 0.05）、较少的缝合材料（P < 0.05）以及距肛门较短的距离（P < 0.001）相关。
在充分进行会阴侧切术后，额外阴道及会阴创伤和肛门括约肌损伤的风险相对较低，与侧方会阴切开术相当。
