拟行盆腔器官脱垂手术的女性肛门括约肌缺陷的流行情况及其与肛门失禁的关系。

Prevalence of anal sphincter defects and association with anal incontinence in women scheduled for pelvic organ prolapse surgery.

机构信息

Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway.

Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

出版信息

Neurourol Urodyn. 2020 Nov;39(8):2409-2416. doi: 10.1002/nau.24504. Epub 2020 Sep 7.

DOI:10.1002/nau.24504

PMID:32894645

Abstract

AIMS

Some women with pelvic organ prolapse (POP) have concomitant symptoms of anal incontinence. Our aim was to assess the prevalence of anal sphincter defects and the association with incontinence in women undergoing POP surgery.

METHODS

Cross-sectional study of 200 women scheduled for POP surgery. They answered yes/no and graded any symptoms of fecal and flatal incontinence on a visual analog scale (0-100). 3D/4D transperineal ultrasound was used to assess internal (IAS) and external anal sphincter (EAS) defects. A defect of ≥30° in ≥4 of 6 slices on tomographic imaging was regarded significant. The association between incontinence and sphincter defects was tested with multivariable logistic regression analysis.

RESULTS

The prevalence of any sphincter defect was 50/200 (25%). Combined IAS/EAS defect was found in 19/200 (9.5%) women, 8/200 (4.0%) had isolated IAS, and 23/200 (11.5%) had isolated EAS defects. In women with defect and intact IAS, 37% and 11% reported fecal incontinence, respectively, adjusted odds ratio (aOR) 2.3 (95% confidence interval [CI], 0.7-7.0), p = .147 and in women with defect versus intact EAS, 36% and 9% had fecal incontinence, aOR 4.0 (95% CI, 1.5-10.8), p = .005. In women with defect and intact IAS, 85% versus 43% reported flatal incontinence, aOR 5.2 (95% CI, 1.6-17.2), p = .007 and in women with defect versus intact EAS, 71% versus 43% had flatal incontinence, aOR 1.9 (95% CI, 0.8-4.5), p = .131.

CONCLUSIONS

One of four women scheduled for POP surgery had an anal sphincter defect. EAS defects were associated with fecal incontinence and IAS defects were strongly associated with flatal incontinence.

摘要

目的

一些患有盆腔器官脱垂（POP）的女性同时伴有肛门失禁症状。我们的目的是评估行 POP 手术的女性中肛门括约肌缺陷的发生率以及与失禁的关系。

方法

对 200 例行 POP 手术的女性进行横断面研究。她们回答了关于粪便和气体失禁的任何症状的是/否问题，并在视觉模拟量表（0-100）上对其严重程度进行了分级。使用 3D/4D 经会阴超声评估内部（IAS）和外部肛门括约肌（EAS）缺陷。在断层成像上 6 个层面中≥4 个层面≥30°的缺陷被认为是显著的。使用多变量逻辑回归分析来检验失禁与括约肌缺陷之间的关系。

结果

任何括约肌缺陷的发生率为 50/200（25%）。200 名女性中有 19 名（9.5%）存在 IAS/EAS 联合缺陷，8 名（4.0%）存在单纯 IAS 缺陷，23 名（11.5%）存在单纯 EAS 缺陷。在有缺陷和完整 IAS 的女性中，分别有 37%和 11%报告有粪便失禁，调整后的优势比（aOR）为 2.3（95%置信区间 [CI]，0.7-7.0），p=0.147；在有缺陷和完整 EAS 的女性中，分别有 36%和 9%报告有粪便失禁，aOR 为 4.0（95%CI，1.5-10.8），p=0.005。在有缺陷和完整 IAS 的女性中，分别有 85%和 43%报告有气体失禁，aOR 为 5.2（95%CI，1.6-17.2），p=0.007；在有缺陷和完整 EAS 的女性中，分别有 71%和 43%报告有气体失禁，aOR 为 1.9（95%CI，0.8-4.5），p=0.131。