Atan Ixora Kamisan, Lin Sylvia, Dietz Hans P, Herbison Peter, Wilson Peter D
Sydney Medical School Nepean, University of Sydney, Australia.
Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
J Ultrasound Med. 2018 Dec;37(12):2829-2839. doi: 10.1002/jum.14641. Epub 2018 Apr 20.
This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP).
This was a cross-sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient-administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data.
Of 195 women who were seen a mean of 23 (range, 19.4-46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9-66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3-54.3) kg/m . Median parity was 3 (range 1-14). Ninety-one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36% (n = 69) had significant POP. Levator avulsion was diagnosed in 16% (n = 31). Mean levator avulsion defect score was 2.2 (range, 0-12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2-5.7), P = .01; and odds ratio 3.3 (1.4-7.7); P = .003, respectively; Ba (P < .001); bladder (P < .001); uterine (P < .001) and rectal ampulla (P = .009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings.
Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.
本研究旨在确定肛提肌撕裂与盆腔器官脱垂（POP）之间的关联。
这是一项横断面研究，纳入了195名参与纵向队列研究的女性，她们在首次分娩20年后接受检查。所有患者均完成了一份标准化的患者自填问卷、国际尿控协会盆腔器官脱垂定量评估以及经阴唇4D超声检查。主要观察指标为临床及经阴唇超声检查发现的客观POP。在对其他数据不知情的情况下，对肛提肌完整性进行影像学后评估，并通过超声确定盆腔器官脱垂情况。
在195名首次分娩后平均23年（范围19.4 - 46.2年）接受检查的女性中，1人拒绝超声检查并被排除，最终纳入194人。平均年龄为50.2岁（范围36.9 - 66.5岁），平均体重指数（BMI）为27.6kg/m²（范围18.3 - 54.3）。中位数产次为3次（范围1 - 14次）。91%（n = 176）为经阴道分娩。18%（n = 34）有脱垂症状。临床检查发现，36%（n = 69）有严重POP。16%（n = 31）被诊断为肛提肌撕裂。肛提肌撕裂缺陷评分平均为2.2分（范围0 - 12分）。单因素分析显示，肛提肌撕裂及肛提肌撕裂缺陷评分与临床及超声检查发现的严重POP相关，即比值比分别为2.6（1.2 - 5.7），P = 0.01；以及比值比3.3（1.4 - 7.7），P = 0.003；Ba（P < 0.001）；膀胱（P < 0.001）；子宫（P < 0.001）和直肠壶腹（P = 0.009）脱垂，但与POP症状以及C和Bp无关。控制潜在混杂因素的多因素分析证实了我们的研究结果。
肛提肌撕裂与女性盆腔器官脱垂相关，尤其是前盆腔和中盆腔。随着年龄增长，这种关联可能会更强。
