Department of Colorectal Surgery, St George Public Hospital, Kogarah, New South Wales, Australia.
St George and Sutherland Clinical School, University of New South Wales, Kensington, New South Wales, Australia.
ANZ J Surg. 2022 May;92(5):1208-1210. doi: 10.1111/ans.17650. Epub 2022 Mar 25.
Obstetric anal sphincter injuries are a common cause of faecal incontinence in women. Symptoms can arise immediately after delivery or have an onset many years postpartum. The anterior sphincter defect may be occult and unrecognised at the time of delivery or result from a breakdown of a primary repair. A delayed sphincteroplasty is a management option for those with persistent symptoms after a non-operative approach. Our patient is a 35-year-old female who presented with faecal urgency and incontinence to liquid stool and flatus. She was 8 months post-partum (G4P2) following a singleton vaginal delivery. She suffered a sphincter injury following a precipitous labour, described as a grade 3c perineal tear, which was repaired at the time in the operating theatre. Endoanal ultrasound revealed a persistent 40% defect in the anterior internal and external anal sphincters. Our approach to a delayed sphincteroplasty is described in detail. We employed a method that involved the identification, careful dissection, and separate repair of both anal sphincter muscles.
产科肛门括约肌损伤是女性粪便失禁的常见原因。症状可能在分娩后立即出现，也可能在产后多年出现。前括约肌缺损可能在分娩时隐匿而未被发现，也可能是初次修复失败的结果。对于那些非手术治疗后持续存在症状的患者，延迟性肛门括约肌成形术是一种治疗选择。
我们的患者是一位 35 岁女性，表现为粪便急迫和失禁，可排液状粪便和气体。她在 G4P2 状态下 8 个月，为单胎经阴道分娩。她在急产中发生了括约肌损伤，会阴裂伤程度为 3c 级，当时在手术室进行了修复。经肛门超声显示，前内、外括约肌持续存在 40%的缺损。我们详细描述了延迟性肛门括约肌成形术的方法。我们采用了一种方法，包括对两块肛门括约肌进行仔细解剖和分别修复。
