Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy.
Int Urogynecol J. 2023 Feb;34(2):493-498. doi: 10.1007/s00192-022-05205-6. Epub 2022 Apr 25.
Minorly skilled gynecologists are less likely to repair obstetric anal sphincter injuries (OASIS), and this can lead to higher rate of de novo onset of pelvic floor dysfunction (PFD). The aim of this study was to understand the impact of surgeon skills in OASIS repair on de novo incidence of PFDs.
An observational prospective cohort study performed between January 2019 and December 2020. We included 116 women with OASIS. At 6-weeks from delivery, women were divided into two groups in relation to the onset of PFDs. Characteristics were compared; categorical and continuous variables were assessed with chi-squared test and the Mann-Whitney rank-sum test respectively. Factors involved in PFDs development were analysed with explorative univariate analysis; significant (p<0.05) or approaching significance (p≤0.10) variables were included in multivariable analysis.
Seventy-six women (76/116; 65.5%) reported at least one PFD symptom and anal incontinence was the most prevalent (44.73%; 34/76). OASIS management by a skilled gynaecologist resulted protective for PFDs [aOR 0.33 (0.13-0.61)]. Skilled surgeon reported fewer PFDs than less skilled surgeon (4% vs 82.4%; p<0.0001). Operative delivery was more performed (32.5% vs 15.8%; p= 0.03) and severe OASIS resulted more prevalent (60% vs 17.1%; p<0.0001) among women without PDFs, even if these didn't affect the incidence of de novo PFDs [aOR 1.03 (0.23-1.45) and 0.83 (0.13-1.45), respectively].
Surgeons skilled in OASIS repair resulted the only protective factor for incidence of de novo PFDs in women with OASIS at 6 weeks of follow up. Improvement of training in OASIS repair is necessary.
技术水平较低的妇科医生不太可能修复产科肛门括约肌损伤（OASIS），这可能导致盆底功能障碍（PFD）新发病例的发生率更高。本研究的目的是了解 OASIS 修复中外科医生技能对 PFD 新发率的影响。
这是一项在 2019 年 1 月至 2020 年 12 月期间进行的观察性前瞻性队列研究。我们纳入了 116 例 OASIS 患者。在分娩后 6 周，根据 PFD 的发病情况将女性分为两组。比较特征；分类和连续变量分别采用卡方检验和曼-惠特尼秩和检验进行评估。采用探索性单因素分析分析 PFD 发病相关因素；将有意义（p<0.05）或接近意义（p≤0.10）的变量纳入多变量分析。
76 名女性（116 名中的 76 名；65.5%）报告至少有一种 PFD 症状，肛门失禁最为常见（44.73%；34/76）。OASIS 由熟练的妇科医生进行管理可预防 PFDs [比值比（OR）0.33（0.13-0.61)]。熟练外科医生报告的 PFD 比技术水平较低的外科医生少（4%比 82.4%；p<0.0001）。阴道分娩的比例更高（32.5%比 15.8%；p=0.03），严重 OASIS 的发生率更高（60%比 17.1%；p<0.0001），但这并不影响新发 PFD 的发生率 [比值比（OR）分别为 1.03（0.23-1.45）和 0.83（0.13-1.45)]。
在 OASIS 随访 6 周的女性中，熟练修复 OASIS 的外科医生是新发 PFD 的唯一保护因素。需要改进 OASIS 修复培训。
