Laterza Rosa Maria, Schrutka Lore, Umek Wolfgang, Albrich Stefan, Koelbl Heinz
Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
Int Urogynecol J. 2015 Jan;26(1):41-7. doi: 10.1007/s00192-014-2456-0. Epub 2014 Jul 10.
The aim of this study was to evaluate pelvic floor dysfunction and anatomical signs of pelvic organ prolapse (POP) in patients with levator ani muscle (LAM) trauma compared with patients with an intact LAM 1 year postpartum.
In a prospective case-control study, primiparous women after vaginal delivery, with LAM trauma diagnosed on 3D ultrasound, were included in the case group. Controls consisted of patients who fulfilled the same inclusion criteria but had an intact levator. All women were investigated 1 year postpartum in respect of bladder, bowel, prolapse, and sexual function using the Australian Pelvic Floor Questionnaire. POP was assessed according to the Pelvic Organ Prolapse Quantification (POP-Q) system and pelvic floor muscle strength using the Oxford Grading Scale.
Forty patients were included: 20 with and 20 without levator trauma. Urinary symptoms were significantly more frequent in women with LAM trauma compared with controls (p = 0.01). The two groups were comparable in respect of bowel, sexual, and prolapse symptoms (p = 0.24, p = 0.60, p = 0.99 respectively). Unlike POP stages II and III, POP stage I was significantly more common in LAM trauma patients (n = 19, 95 %) than in controls (n = 10, 50 %) (p =0.003). A positive association was noted between POP stage I and LAM trauma (RR = 7.2). The involvement of multiple compartments was significantly more frequent in cases than in controls (p = 0.003).
Except for urinary symptoms, LAM trauma was asymptomatic in nearly all patients 1 year postpartum. However, POP stage I involving multiple compartments occurred more frequently in LAM trauma patients than in controls.
本研究的目的是评估与产后1年肛提肌（LAM）完整的患者相比，LAM损伤患者的盆底功能障碍及盆腔器官脱垂（POP）的解剖学征象。
在一项前瞻性病例对照研究中，经三维超声诊断为LAM损伤的初产妇阴道分娩后被纳入病例组。对照组由符合相同纳入标准但肛提肌完整的患者组成。所有女性在产后1年使用澳大利亚盆底问卷对膀胱、肠道、脱垂和性功能进行调查。根据盆腔器官脱垂定量（POP-Q）系统评估POP，并使用牛津分级量表评估盆底肌肉力量。
共纳入40例患者：20例有LAM损伤，20例无LAM损伤。与对照组相比，LAM损伤女性的泌尿系统症状明显更频繁（p = 0.01）。两组在肠道、性和脱垂症状方面具有可比性（分别为p = 0.24、p = 0.60、p = 0.99）。与POP II期和III期不同，POP I期在LAM损伤患者中（n = 19，95%）比对照组（n = 10，50%）更常见（p = 0.003）。POP I期与LAM损伤之间存在正相关（RR = 7.2）。病例组中多个腔室受累的频率明显高于对照组（p = 0.003）。
除泌尿系统症状外，几乎所有产后1年的患者中LAM损伤均无症状。然而，LAM损伤患者中涉及多个腔室的POP I期比对照组更频繁发生。
