Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tan E, Tekkis P
Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK.
Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust , London , UK.
Ann R Coll Surg Engl. 2018 Jan;100(1):26-32. doi: 10.1308/rcsann.2017.0140. Epub 2017 Sep 15.
Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.
引言 本研究旨在确定分娩时漏诊的产科肛门括约肌损伤在功能和生活质量方面的结局是否比分娩后立即进行初次修复更差。材料与方法 对在三级盆底疾病治疗机构就诊的患者进行2:1倾向评分匹配，这些患者在分娩后24个月内经超声检查证实存在漏诊的产科肛门括约肌损伤，将其与分娩时进行初次修复的患者按产次、损伤程度和评估时间进行匹配。比较的结局包括伯明翰肠道、膀胱和泌尿症状问卷（BBUSQ）、韦克斯纳失禁评分、简明健康状况调查量表（Short Form-36）、盆腔器官脱垂/尿失禁性功能问卷以及肛肠生理结果。结果 32例漏诊的肛门括约肌损伤患者与62例进行肛门括约肌缺损初次修复的患者按2:1进行匹配。平均随访时间为9.31±6.79个月。漏诊肛门括约肌损伤的患者失禁情况更严重，如伯明翰肠道、膀胱和泌尿症状问卷（BBUSQ；30.56%±14.41% 对19.75%±15.65%，P = 0.002）和韦克斯纳评分（6.00±3.76对3.67±4.06，P = 0.009）更高所示。他们的BBUSQ泌尿领域评分也更差（28.25%±14.9%对17.01±13.87%，P = 0.001），并且根据简明健康状况调查量表问卷测量的身体功能更差（P = 0.045）。在其他比较的结局中没有差异，包括肛肠生理和性功能。讨论 在短期内，漏诊的产科肛门括约肌损伤患者的大便失禁和泌尿功能评分明显更差，然而两组之间的生活质量和性功能在很大程度上具有可比性。结论 需要进行更长时间的随访以评估漏诊的产科肛门括约肌损伤随时间的影响。
