Viannay P, de la Codre F, Brochard C, Thubert T, Meurette G, Legendre G, Venara A
Department of visceral and endocrine surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculté de santé d'Angers, Department of Medicine, Angers, France.
Digestive and endocrine surgery clinic, IMAD, Hôtel Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
J Visc Surg. 2021 Jun;158(3):231-241. doi: 10.1016/j.jviscsurg.2020.10.010. Epub 2021 Jan 14.
Obstetrical anal sphincter injuries (OASI), formerly referred to as "complete" or "incomplete" perineal tears, are a frequent complication of childbirth. They can lead to intestinal consequences (anal incontinence, ano-genital fistula) or sexual consequences (dyspareunia, genital pain). The complexity of management of OASI lies in the multi-factorial nature of these consequences but also in the frequently lengthy interval before their appearance, often long after childbirth. Indeed, while 2.4% of women in childbirth develop OASI, up to 61% of them will present with anal incontinence15 to 25 years after childbirth. Immediate or delayed repair of the sphincter and perineum within a few hours of injury is therefore the rule, but there is no consensus on longer-term management. The patient must be educated on preventive actions (avoidance of pushing or straining, regularization of stool transit, muscle strengthening, etc.). Early detection of anal incontinence leads to prompt management, which is more effective. This review aims to synthesize the information necessary to provide clear and up-to-date patient information on OASI (risk factors and prevalence), the management of OASI, and the management of eventual complications in the setting of dedicated specialty consultations. Dedicated "post-OASI" consultations by a specialist in ano-perineal pathologies could therefore become a first step in the development of care for women, particularly by removing the "shameful" nature of the symptoms.
产科肛门括约肌损伤（OASI），以前被称为“完全性”或“不完全性”会阴撕裂，是分娩常见的并发症。它们可导致肠道问题（肛门失禁、肛门生殖器瘘）或性方面的问题（性交困难、生殖器疼痛）。OASI管理的复杂性不仅在于这些后果具有多因素性质，还在于其出现前的间隔时间往往很长，通常是在分娩后很久。事实上，虽然2.4%的分娩女性会发生OASI，但其中高达61%的人会在分娩后15至25年出现肛门失禁。因此，在损伤后数小时内立即或延迟修复括约肌与会阴是常规做法，但对于长期管理尚无共识。必须对患者进行预防措施教育（避免用力屏气、使排便规律、加强肌肉锻炼等）。早期发现肛门失禁可促使及时管理，这样更有效。本综述旨在综合必要信息，以便就OASI（危险因素和患病率）、OASI的管理以及在专门专科会诊情况下对最终并发症的管理，为患者提供清晰和最新的信息。因此，由肛门会阴疾病专家进行专门的“OASI后”会诊可能成为为女性制定护理方案的第一步，特别是通过消除症状的“羞耻性”。
