Garner Danielle K, Patel Akash B, Hung Jun, Castro Monica, Segev Tamar G, Plochocki Jeffrey H, Hall Margaret I
Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308, USA.
College of Graduate Studies, Midwestern University, Glendale, AZ 85308, USA.
Diagnostics (Basel). 2021 Feb 2;11(2):221. doi: 10.3390/diagnostics11020221.
Episiotomy is the surgical incision of the vaginal orifice and perineum to ease the passage of an infant's head while crowning during vaginal delivery. Although episiotomy remains one of the most frequently performed surgeries around the world, short- and long-term complications from the procedure are not uncommon. We performed midline and mediolateral episiotomies with the aim of correlating commonly diagnosed postepisiotomy complications with risk of injury to perineal neuromuscular and erectile structures. We performed 61 incisions on 47 female cadavers and dissected around the incision site. Dissections revealed that midline incisions did not bisect any major neuromuscular structures, although they did increase the risk of direct and indirect injury to the subcutaneous portion of the external anal sphincter. Mediolateral incisions posed greater risk of iatrogenic injury to ipsilateral nerve, muscle, erectile, and gland tissues. Clinician discretion is advised when weighing the potential risks to maternal perineal anatomy during vaginal delivery when episiotomy is indicated. If episiotomy is warranted, an understanding of perineal anatomy may benefit diagnosis of postsurgical complications.
会阴切开术是指在阴道分娩时，在胎儿头部娩出时切开阴道口和会阴，以利于胎儿头部通过。尽管会阴切开术仍然是世界上最常施行的手术之一，但该手术的短期和长期并发症并不罕见。我们进行了正中会阴切开术和中侧会阴切开术，目的是将常见的会阴切开术后并发症与会阴神经肌肉和勃起结构损伤的风险相关联。我们在47具女性尸体上进行了61次切口，并在切口部位周围进行解剖。解剖显示，正中切口并未切断任何主要神经肌肉结构，尽管它们确实增加了对外括约肌皮下部分直接和间接损伤的风险。中侧切口对同侧神经、肌肉、勃起组织和腺体组织造成医源性损伤的风险更大。当在阴道分娩时需要进行会阴切开术时，在权衡对产妇会阴解剖结构的潜在风险时，建议临床医生谨慎判断。如果有必要进行会阴切开术，了解会阴解剖结构可能有助于诊断术后并发症。
