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产科肛门括约肌损伤(OASIs)的早期二期修复:经验和文献复习。

Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature.

机构信息

Croydon University Hospital, Thornton Heath, CR7 7YE, UK.

St George's University of London, London, UK.

出版信息

Int Urogynecol J. 2021 Jul;32(7):1611-1622. doi: 10.1007/s00192-021-04822-x. Epub 2021 May 15.

Abstract

INTRODUCTION AND HYPOTHESIS

Secondary anal sphincter repair for a dehisced obstetric anal sphincter injury (OASI) is required following 2.6% of primary repairs. There is growing evidence that instead of delaying repair for 3-6 months, early secondary repair of the anal sphincter can be completed within 14 days. Our aims were to review the literature and to describe experiences in our unit.

METHODS

This is a narrative review of all published cases reporting outcomes of early secondary repair of dehisced OASIs. In addition, we report a series from Croydon University Hospital (CUH) between 2010 and 2019.

RESULTS

Ninety patients from five studies were identified on literature search. Six patients from CUH were included in the case series. Overall, the most common complications following secondary repair included skin dehiscence [10.3% (n = 10)], infection [5.2% (n = 5)] and fistula formation [8.2% (n = 8)]. In our case series, following secondary repair, normal manometric incremental squeeze pressure was found in five women (83%). Also, on endoanal ultrasound, internal anal sphincter (IAS) defects were found in 75% with a history of IAS injury (n = 4). There were no full-thickness external anal sphincter defects. Compared to those requiring primary repair alone, residual defects were significantly larger in those who also underwent secondary repair (Starck score 2.1 vs. 5.7, p = 0.01).

CONCLUSION

Early secondary repair is a feasible surgical procedure for the reconstruction of dehisced OASIs. This case series and review of the literature can be used to support clinicians in the management of primary OASI repair dehiscence.

摘要

引言和假设

产科肛门括约肌损伤(OASI)初次修复后,有 2.6%需要进行二次肛门括约肌修复。越来越多的证据表明,与其延迟修复 3-6 个月,不如在 14 天内完成早期二次肛门括约肌修复。我们的目的是回顾文献并描述我们单位的经验。

方法

这是一项对所有报告早期二次修复裂开的 OASI 结果的已发表病例的叙述性综述。此外,我们还报告了 2010 年至 2019 年期间克罗伊登大学医院(CUH)的一系列病例。

结果

通过文献检索,在五项研究中确定了 90 例患者。病例系列中纳入了来自 CUH 的六名患者。总体而言,二次修复后最常见的并发症包括皮肤裂开[10.3%(n=10)]、感染[5.2%(n=5)]和瘘管形成[8.2%(n=8)]。在我们的病例系列中,二次修复后,5 名女性(83%)的肛门测压递增收缩压正常。此外,在经肛门超声检查中,有 IAS 损伤史(n=4)的患者中 IAS 缺陷发现率为 75%。没有完全性外括约肌缺陷。与仅接受初次修复的患者相比,那些接受二次修复的患者的残留缺陷明显更大(Starck 评分 2.1 与 5.7,p=0.01)。

结论

早期二次修复是重建裂开的 OASI 的可行手术方法。本病例系列和文献复习可用于支持临床医生处理初次 OASI 修复裂开的情况。

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