初产妇产科肛门括约肌损伤后肛门失禁的发生率及预测因素
Incidence and Predictors of Anal Incontinence After Obstetric Anal Sphincter Injury in Primiparous Women.
作者信息
Richter Holly E, Nager Charles W, Burgio Kathryn L, Whitworth Ryan, Weidner Alison C, Schaffer Joseph, Zyczynski Halina M, Norton Peggy, Jelovsek John Eric, Meikle Susan F, Spino Cathie, Gantz Marie, Graziano Scott, Brubaker Linda
机构信息
From the *Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; †Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA; ‡Deparment of Gerontology, Geriatrics and Pallative Care, Veterans Administration GRECC, Birmingham, AL; §Research Triangle Institute, Research Triangle Park; ∥Department of Obstetrics and Gynecology, Duke University, Durham, NC; ¶Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX; **Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA; ††Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; ‡‡Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH; §§Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; ∥∥Department of Biostatistics, University of Michigan, Ann Arbor, MI; and ¶¶Department of Obstetrics and Gynecology, Loyola University Chicago, Chicago, IL.
出版信息
Female Pelvic Med Reconstr Surg. 2015 Jul-Aug;21(4):182-9. doi: 10.1097/SPV.0000000000000160.
OBJECTIVE
This study aimed to describe the incidence of fecal incontinence (FI) at 6, 12, and 24 weeks postpartum; anal incontinence (AI) and fecal urgency at 24 weeks; and identify predictors of AI in women with obstetric anal sphincter injury (OASI).
METHODS
Primiparous women sustaining OASIs were identified at 8 clinical sites. Third-degree OASIs were characterized using World Health Organization criteria, 3a (<50%) or 3b (>50%) tear through the sphincter. Fecal incontinence was defined as leakage of liquid/solid stool and/or mucus in the past month; AI was defined as leakage of liquid/solid stool and/or mucus and/or gas in the past month and was assessed at 6, 12, and 24 weeks postpartum using the Fecal Incontinence Severity Index. Logistic regression identified variables associated with AI.
RESULTS
Three hundred forty-three women participated: 297 subjects sustained a third-degree OASI, 168 type 3a, 98 type 3b and 31 indeterminant; 45 had a fourth-degree OASI. Overall FI incidence at 6, 12, and 24 weeks was 7% [23/326; 95% confidence interval (CI), 4%-10%], 4% (6/145; 95% CI, 2%-9%), and 9% (13/138; 95% CI, 5%-16%), respectively. At 24 weeks, AI incidence was 24% (95% CI, 17%-32%) and fecal urgency 21% (95% CI, 15%-29%). No significant differences in FI and AI rates were noted by third-degree type or between groups with third and fourth OASI. Flatal incontinence was greater in women sustaining a fourth-degree tear (35% vs 16%, P = 0.04). White race (adjusted odds ratio, 4.64; 95% CI, 1.35-16.02) and shorter duration of second stage (adjusted odds ratio, 1.47 per 30 minute decrease; 95% CI, 1.12-1.92) were associated with AI at 24 weeks.
CONCLUSIONS
Overall 24-week incidence of FI is 9% (95% CI, 5%-16%) and AI is 24% (95% CI, 17%-32%). In women with OASI, white race and shorter second-stage labor were associated with postpartum AI.
CLINICAL TRIAL REGISTRATION
NCT01166399 (http://clinicaltrials.gov).
目的
本研究旨在描述产后6周、12周和24周时大便失禁（FI）的发生率；24周时肛门失禁（AI）和大便急迫感的发生率；并确定产科肛门括约肌损伤（OASI）女性中AI的预测因素。
方法
在8个临床地点识别出发生OASI的初产妇。使用世界卫生组织标准对三度OASI进行分类，即括约肌撕裂3a（<50%）或3b（>50%）。大便失禁定义为过去一个月内有液体/固体粪便和/或黏液泄漏；AI定义为过去一个月内有液体/固体粪便和/或黏液和/或气体泄漏，并在产后6周、12周和24周使用大便失禁严重程度指数进行评估。逻辑回归确定与AI相关的变量。
结果
343名女性参与研究：297名受试者发生三度OASI，其中168例为3a型，98例为3b型，31例不确定；45例发生四度OASI。6周、12周和24周时FI的总体发生率分别为7%[23/326；95%置信区间（CI），4%-10%]、4%（6/145；95%CI，2%-9%）和9%（13/138；95%CI，5%-16%）。在24周时，AI发生率为24%（95%CI，17%-32%），大便急迫感发生率为21%（95%CI，15%-29%）。三度类型或三度与四度OASI组之间的FI和AI发生率无显著差异。四度撕裂女性的排气失禁发生率更高（35%对16%，P=0.04）。白人种族（调整优势比，4.64；95%CI，1.35-16.02）和第二产程持续时间较短（每减少30分钟调整优势比为1.47；95%CI，1.12-1.92）与24周时的AI相关。
结论
24周时FI的总体发生率为9%（95%CI，5%-16%），AI为24%（95%CI，17%-32%）。在OASI女性中，白人种族和第二产程较短与产后AI相关。
临床试验注册
NCT0116639（http://clinicaltrials.gov）
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