Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2021 Feb;61(1):16-21. doi: 10.1111/ajo.13261. Epub 2020 Oct 15.
Obstetric anal sphincter injuries (OASIs) are a significant complication of vaginal delivery, and a leading cause of anal incontinence in women.
The aims were to explore the management of OASIs in Australia and New Zealand (ANZ) by colorectal surgeons and how this compares with current recommendations and international experience, and to identify the deterrents to the provision of best-practice care among colorectal surgeons.
Three hundred colorectal surgeons of the Colorectal Surgical Society of ANZ were mailed questionnaires. Areas of interest included: surgeon demographics; exposure to OASIs; understanding of current recommendations; and opinions regarding the importance of symptoms and assessment tools in OASIs.
There were 94 completed questionnaires (response rate 31.3%). Fifty-seven surgeons (60.6%) reported low exposure to OASIs during their fellowship training. Greater than 90% believed patients with grade three tears and above should have anal sphincter assessment. Sixty-six (70.2%) reported that they routinely review women who have had OASIs. However, 56.4% were unaware if their obstetrics department followed a standard protocol for OASIs. Surgeons practising in metropolitan centres reported higher rates of their obstetrics department following a protocol (P = 0.013), and greater access to investigative tools (P < 0.001), when compared to rural-based surgeons.
Most ANZ colorectal surgeons have had minimal training in OASI management. Colorectal surgeons are more commonly involved with OASI patients in the non-acute setting. Management protocols involving a multidisciplinary team of both colorectal surgeons and obstetricians should be clearly defined, and the gap between metropolitan and rural centres needs to be reviewed.
产科肛门括约肌损伤（OASIs）是阴道分娩的严重并发症，也是女性肛门失禁的主要原因。
本研究旨在探讨澳大利亚和新西兰（ANZ）的结直肠外科医生对 OASIs 的处理方法，并将其与当前的建议和国际经验进行比较，同时确定结直肠外科医生在提供最佳实践护理方面的障碍。
向 ANZ 结直肠外科学会的 300 名结直肠外科医生邮寄了调查问卷。感兴趣的领域包括：外科医生的人口统计学特征；对 OASIs 的了解；对当前建议的理解；以及对症状和评估工具在 OASIs 中的重要性的看法。
共收到 94 份完整的问卷（应答率 31.3%）。57 名外科医生（60.6%）报告在其专科培训期间对 OASIs 的接触较少。超过 90%的外科医生认为，三级及以上撕裂的患者应进行肛门括约肌评估。66 名（70.2%）外科医生报告他们定期复查有 OASIs 的女性。然而，56.4%的人不知道他们的妇产科部门是否遵循 OASIs 的标准协议。与农村地区的外科医生相比，在大都市中心工作的外科医生报告其妇产科部门更有可能遵循协议（P=0.013），并且更容易获得检查工具（P<0.001）。
大多数 ANZ 结直肠外科医生在 OASI 管理方面的培训较少。结直肠外科医生更常参与非急性 OASI 患者的治疗。涉及结直肠外科医生和妇产科医生多学科团队的管理协议应明确规定，并需要审查大都市和农村中心之间的差距。
