经肛门、经阴道或经会阴超声诊断括约肌缺陷与肛门失禁的相关性哪个更强？
Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?
机构信息
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, Trondheim University Hospital, P.O. Box 3250, Sluppen, 7006, Trondheim, Norway.
出版信息
Int Urogynecol J. 2020 Jul;31(7):1471-1478. doi: 10.1007/s00192-020-04274-9. Epub 2020 Mar 20.
INTRODUCTION AND HYPOTHESIS
Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure.
METHODS
We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013-2015. They were examined 6-12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann-Whitney U test.
RESULTS
At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs internal defect: 27% vs 13%, p < 0.05. On TPUS, more women with defect sphincters had flatal AI: 32% vs 13%, p = 0.03. No difference was found on IUS. Difference between defect and intact sphincters on EAUS, IUS and TPUS respectively was found for mean [SD] maximum anal resting pressure (48 [13] vs 55 [14] mmHg; 48 [12] vs 56 [13] mmHg; 50 [13] vs 54 [14] mmHg) and squeeze incremental pressure (33 [17] vs 49 [28] mmHg; 37 [23] vs 50 [28] mmHg; 36 [18] vs 50 [30] mmHg; p < 0.01).
CONCLUSIONS
Endoanal ultrasound had the strongest association with AI symptoms 2 years after OASI. Sphincter defects detected using all ultrasound methods were associated with lower anal pressure.
引言和假设
我们的目的是探讨经阴道三维超声（3D EAUS）、阴道入口超声（IUS）和经会阴超声（TPUS）诊断的产后肛门括约肌损伤（OASI）后持续性肛门括约肌缺陷与肛门失禁（AI）之间的关系，并研究括约肌缺陷与肛门压力之间的关系。
方法
我们对 2013 年至 2015 年期间招募的 250 名 OASI 女性进行了横断面研究。这些女性在产后 6-12 周或后续妊娠时接受了 3D EAUS、IUS 和 TPUS 检查，并测量了肛门压力。使用卡方检验和曼-惠特尼 U 检验比较了有缺陷和无缺陷（离线诊断）的女性在急迫/固体/液体 AI 或放屁 AI 发生率和肛门压力方面的差异。
结果
OASI 后平均 23.6（标准差 30.1）个月时，与 EAUS 下有完整括约肌的女性相比，有缺陷的女性 AI 发生率更高；急迫/固体/液体 AI 与外部缺陷：36% vs 13%和放屁 AI 与内部缺陷：27% vs 13%，p<0.05。在 TPUS 上，有缺陷的括约肌女性放屁 AI 发生率更高：32% vs 13%，p=0.03。IUS 上没有差异。在 EAUS、IUS 和 TPUS 上，缺陷和完整括约肌之间的差异分别为平均最大肛门静息压力（48[13] vs 55[14]mmHg；48[12] vs 56[13]mmHg；50[13] vs 54[14]mmHg）和最大收缩增量压力（33[17] vs 49[28]mmHg；37[23] vs 50[28]mmHg；36[18] vs 50[30]mmHg；p<0.01）。
结论
在 OASI 后 2 年，经阴道超声与 AI 症状的相关性最强。所有超声方法检测到的括约肌缺陷与较低的肛门压力相关。
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