Department of Obstetrics and Gynecology, Helsingborg Hospital, Fredrik Cöstersgata 6, 254 43, Helsingborg, Sweden.
Department of Clinical Sciences, Lund University, Malmö, Sweden.
J Ultrasound. 2021 Sep;24(3):261-267. doi: 10.1007/s40477-020-00485-4. Epub 2020 May 31.
The aim of the study was to investigate the association between the initial grade of obstetrical anal sphincter injury (OASIS), and Wexner score parameters, with ultrasonographic findings by endoanal ultrasound (EAUS, golden standard) and transperineal ultrasound (TPUS) 6 months post-partum.
Fifty-nine women after primary repair of OASIS were included at Helsingborg Hospital, Sweden, 2016-2017. Six months post-partum the women filled in a questionnaire regarding symptoms of anal incontinence by the Wexner score and were scanned with EAUS and TPUS (resting state and contracting state) for classification of the residual defect by a modified Starck score.
Correlations were found between the OASIS grade and residual defects; length (r = 0.41, P = 0.003), depth (r = 0.38, P = 0.006) and angle (r = 0.40, P = 0.004) of the external anal sphincter (EAS) measured with TPUS in resting state. Using EAUS, correlation between OASIS grade and EAS depth (r = 0.35, P = 0.007) and angle (r = 0.37, P = 0.004) were similar, but there was no correlation with length (r = 0.20, P = 0.14). Between incontinence to gas and the angle of the residual defect in the IAS using TPUS in resting state, correlation was moderate (r = 0.42, P = 0.003). Regarding incontinence to liquid stool, measurements by TPUS in resting state of EAS residual defect depth (r = 0.46, P < 0.001) and angle (r = 0.44, P = 0.001) also correlated moderately. Both corresponding correlations using EAUS were weaker.
Defects measured with EAUS and TPUS six months post-partum correlated to initial OASIS grade and symptoms of anal incontinence. Specific symptoms correlated with specific anatomical defects, and TPUS was not an inferior method to EAUS.
本研究旨在探讨产科肛门括约肌损伤（OASIS）初始分级与产后 6 个月的经肛门超声（EAUS，金标准）和经会阴超声（TPUS）的 Wexner 评分参数与超声发现之间的关系。
2016-2017 年，在瑞典赫尔辛堡医院纳入了 59 例初次修复 OASIS 的女性。产后 6 个月，这些女性通过 Wexner 评分填写了关于肛门失禁症状的问卷，并接受 EAUS 和 TPUS（静息状态和收缩状态）扫描，以改良的 Starck 评分对残留缺陷进行分类。
OASIS 分级与残余缺陷之间存在相关性；TPUS 静息状态下测量的外括约肌（EAS）的长度（r=0.41，P=0.003）、深度（r=0.38，P=0.006）和角度（r=0.40，P=0.004）；使用 EAUS 时，OASIS 分级与 EAS 深度（r=0.35，P=0.007）和角度（r=0.37，P=0.004）之间的相关性相似，但与长度无关（r=0.20，P=0.14）。在 TPUS 静息状态下，IAS 残余缺陷角度与气体失禁之间存在中度相关性（r=0.42，P=0.003）。对于液体粪便失禁，TPUS 静息状态下 EAS 残余缺陷深度（r=0.46，P<0.001）和角度（r=0.44，P=0.001）的测量值也存在中度相关性。使用 EAUS 的相应相关性较弱。
产后 6 个月的 EAUS 和 TPUS 测量的缺陷与初始 OASIS 分级和肛门失禁症状相关。特定症状与特定的解剖缺陷相关，且 TPUS 并非 EAUS 的劣等方法。
