Pelvic Floor Unit, Department of Gynecology and Obstetrics, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Tech Coloproctol. 2020 Mar;24(3):221-229. doi: 10.1007/s10151-019-02146-z. Epub 2020 Feb 4.
An early secondary repair of the anal sphincter may be necessary if primary repair of obstetric anal sphincter injury (OASIS) is complicated by wound rupture or severe infection. The objective of this study was to assess the long-term functional outcomes, morbidity, and impact on quality of life (QoL) following an early secondary repair of OASIS.
This retrospective cohort study was conducted at Aarhus University Hospital, Denmark. All women having a secondary repair of the anal sphincter within 21 days of delivery from February 1991 to February 2017 were included (n = 51). Complications were assessed by reviewing medical records. The patient-reported outcomes were assessed in 2018 by questionnaires. Primary outcome was Wexner score and St. Mark's score. Impact on QoL was assessed using the Fecal Incontinence Quality of Life Scale (FIQLS).
After a median follow-up time of 6.7 years (IQR 3.3-16.6), 34 women completed the questionnaire. The mean (SD) Wexner score was 5.2 ± 4.7 and the mean (SD) St. Mark's score was 6.8 ± 5.7. Women with a Wexner score ≥ 9 had a significantly lower QoL score in all domains of the FIQLS compared to women with a Wexner score < 9 (p < 0.001). Postoperative complications were experienced by 37%. Ten women developed a fistula of which nine required surgical treatment.
An early secondary repair of the anal sphincter can be performed within 21 days of delivery with functional long-term outcomes comparable to those following a late sphincter repair. However, there is an imminent risk of complications, mainly fistulas, which should be taken into consideration when choosing the ideal timing of the repair.
如果产科肛门括约肌损伤（OASIS）的初次修复因伤口破裂或严重感染而变得复杂，则可能需要早期进行二次肛门括约肌修复。本研究旨在评估 OASIS 早期二次修复后长期的功能结果、发病率以及对生活质量（QoL）的影响。
这是一项在丹麦奥胡斯大学医院进行的回顾性队列研究。纳入了 1991 年 2 月至 2017 年 2 月期间分娩后 21 天内进行二次肛门括约肌修复的所有女性（n=51）。通过查阅病历评估并发症。2018 年通过问卷调查评估患者报告的结果。主要结局是 Wexner 评分和 St. Mark's 评分。使用粪便失禁生活质量量表（FIQLS）评估对 QoL 的影响。
中位随访时间为 6.7 年（IQR 3.3-16.6），34 名女性完成了问卷调查。Wexner 评分的平均值（标准差）为 5.2±4.7，St. Mark's 评分的平均值（标准差）为 6.8±5.7。Wexner 评分≥9 的女性在 FIQLS 的所有领域的 QoL 评分均显著低于 Wexner 评分<9 的女性（p<0.001）。37%的女性发生了术后并发症。10 名女性发生了瘘管，其中 9 名需要手术治疗。
OASIS 的早期二次修复可以在分娩后 21 天内进行，其功能长期结果与晚期括约肌修复相当。然而，存在明显的并发症风险，主要是瘘管，在选择修复的理想时机时应考虑到这一点。
