Nyangoh Timoh K, Bessede T, Zaitouna M, Peschaud F, Chevallier J-M, Fauconnier A, Benoit G, Moszkowicz D
Inserm-UMR 1195 « petites molécules de neuroprotection, neurorégénération et remyélinisation », hôpital de Bicêtre, bâtiment Grégory-Pincus, 80, rue du Général-Leclerc, 94276 Le-Kremlin-Bicêtre cedex, France; Laboratoire de chirurgie expérimentale, faculté de médecine de l'université Paris Sud-11, 63, rue Gabriel-Péri, 94270, Le-Kremlin-Bicêtre, France; Unité de recherche en développement, imagerie et anatomie, EA4465 URDIA, université Paris Descartes, 45, rue des Saints-Pères, 75270 Paris cedex 06, France.
Inserm-UMR 1195 « petites molécules de neuroprotection, neurorégénération et remyélinisation », hôpital de Bicêtre, bâtiment Grégory-Pincus, 80, rue du Général-Leclerc, 94276 Le-Kremlin-Bicêtre cedex, France; Laboratoire de chirurgie expérimentale, faculté de médecine de l'université Paris Sud-11, 63, rue Gabriel-Péri, 94270, Le-Kremlin-Bicêtre, France.
Gynecol Obstet Fertil. 2015 Jan;43(1):84-90. doi: 10.1016/j.gyobfe.2014.11.015. Epub 2014 Dec 24.
Pelvic floor disorders include urogenital and anorectal prolapse, urinary and faecal incontinence. These diseases affect 25% of patients. Most of time, treatment is primarily surgical with a high post-operative risk of recurrence, especially for pelvic organ prolapse. Vaginal delivery is the major risk factor for pelvic floor disorders through levator ani muscle injury or nerve damage. After vaginal delivery, 20% of patients experiment elevator ani trauma. These injuries are more common in case of instrumental delivery by forceps, prolonged second phase labor, increased neonatal head circumference and associated anal sphincter injuries. Moreover, 25% of patients have temporary perineal neuropathy. Recently, pelvic three-dimensional reconstructions from RMI data allowed a better understanding of detailed levator ani muscle morphology and gave birth to a clear new nomenclature describing this muscle complex to be developed. Radiologic and anatomic studies have allowed exploring levator ani innervation leading to speculate on the muscle and nerve damage mechanisms during delivery. We then reviewed the levator ani muscle anatomy and innervation to better understand pelvic floor dysfunction observed after vaginal delivery.
盆底功能障碍包括泌尿生殖和肛肠脱垂、尿失禁和大便失禁。这些疾病影响25%的患者。大多数情况下，治疗主要是手术治疗，术后复发风险高，尤其是盆腔器官脱垂。阴道分娩是盆底功能障碍的主要危险因素，可通过肛提肌损伤或神经损伤导致。阴道分娩后，20%的患者会出现肛提肌创伤。这些损伤在使用产钳器械分娩、第二产程延长、新生儿头围增加以及伴有肛门括约肌损伤的情况下更为常见。此外，25%的患者有暂时性会阴神经病变。最近，基于磁共振成像（RMI）数据的盆腔三维重建使人们能够更好地了解肛提肌的详细形态，并催生了一种描述该肌肉复合体的清晰新命名法。放射学和解剖学研究使人们能够探索肛提肌的神经支配，从而推测分娩过程中肌肉和神经的损伤机制。然后，我们回顾了肛提肌的解剖结构和神经支配，以更好地理解阴道分娩后观察到的盆底功能障碍。
