Guzmán Rojas Rodrigo, Quintero Christian, Shek Ka Lai, Dietz Hans Peter
Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia,
Int Urogynecol J. 2015 May;26(5):737-41. doi: 10.1007/s00192-014-2560-1. Epub 2015 Mar 10.
Rectoceles are common among parous women and they are believed to be due to disruption or distension of the rectovaginal septum as a result of childbirth. However, the etiology of rectocele is likely to be more complex since posterior compartment prolapse does occur in nulliparous women. This study was designed to determine the role of childbearing as an etiological factor in true radiological rectocele.
This was a secondary analysis of the data from 657 primiparous women recruited as part of a previously reported study and another ongoing prospective study. Women were invited for antenatal and postnatal appointments comprising an interview, clinical examination and translabial ultrasonography. The presence and depth of any rectocele were determined on maximum Valsalva maneuver, as was descent of the rectal ampulla. Potential demographic and obstetric factors as predictors of rectocele development were evaluated using either multiple regression or logistic regression analysis as appropriate.
A true rectocele was identified in 4% of women antenatally and in 16% after childbirth (P < 0.001). Mean rectocele depth was 13.5 mm (10 - 23.2 mm). The mean antepartum position of the rectal ampulla on Valsalva maneuver was 4.39 mm above and it was 1.64 mm below the symphysis pubis postpartum (P < 0.0001). De novo appearance of true rectocele was significantly associated with a history of previous <20 weeks pregnancy and fetal birth weight. Body mass index and length of the second stage were associated with rectocele depth increase.
Childbirth seems to play a distinct role in the pathogenesis of rectocele. Both maternal and fetal factors seem to contribute.
直肠膨出在经产妇中很常见，人们认为这是分娩导致直肠阴道隔破裂或扩张所致。然而，直肠膨出的病因可能更为复杂，因为未生育女性也会出现后盆腔器官脱垂。本研究旨在确定生育作为真正影像学直肠膨出病因学因素的作用。
这是对657名初产妇数据的二次分析，这些初产妇是之前一项已报道研究及另一项正在进行的前瞻性研究的一部分。邀请这些女性进行产前和产后检查，包括访谈、临床检查和经阴唇超声检查。在最大瓦尔萨尔瓦动作时确定是否存在直肠膨出及其深度，同时确定直肠壶腹的下降情况。使用多元回归或逻辑回归分析（视情况而定）评估作为直肠膨出发展预测因素的潜在人口统计学和产科因素。
产前4%的女性被诊断为真正的直肠膨出，产后这一比例为16%（P<0.001）。直肠膨出平均深度为13.5毫米（10 - 23.2毫米）。瓦尔萨尔瓦动作时直肠壶腹产前平均位置在耻骨联合上方4.39毫米，产后在耻骨联合下方1.64毫米（P<0.0001）。真正直肠膨出的新发与既往妊娠<20周及胎儿出生体重史显著相关。体重指数和第二产程时长与直肠膨出深度增加有关。
分娩似乎在直肠膨出的发病机制中起独特作用。母体和胎儿因素似乎都有影响。
