Gynaecology and Obstetrics, Uniklinik RWTH Aachen, Aachen, Germany.
Department of Economics and Business Administration, Hochschule Stralsund, Stralsund, Germany.
BMC Womens Health. 2022 Aug 10;22(1):339. doi: 10.1186/s12905-022-01915-7.
The aim of this study was to examine whether OASIS, and its extent, can be confirmed or excluded using transperineal ultrasound (TPUS). A further objective of this study was to monitor the healing process over a period of 6 months and to establish a connection between the sonographic appearance of obstetric anal sphincter injury (OASIS) and anal incontinence.
In this retrospective clinical study, women with OASIS who gave birth between March 2014 and August 2019 were enrolled. All the patients underwent TPUS 3 days and 6 months after delivery. A GE E8 Voluson ultrasound system with a 3.5-5 MHz ultrasound probe was used. The ultrasound images showed a third-degree injury, with the measurement of the width of the tear and its extent (superficial, partial, complete, EAS and IAS involvement). A positive contraction effect, a sign of sufficient contraction, was documented. Six months after delivery, a sonographic assessment of the healing (healed, scar or still fully present) was performed. A Wexner score was obtained from each patient. The patients' medical histories, including age, parity, episiotomy and child's weight, were added.
Thirty-one of the 55 recruited patients were included in the statistical evaluation. Three patients were excluded from the statistical evaluation because OASIS was excluded on TPUS 3 days after delivery. One patient underwent revision surgery for anal incontinence and an inadequately repaired anal sphincter injury, as shown sonographic assessment, 9 days after delivery. Twenty patients were excluded for other reasons. The results suggest that a tear that appears smaller (in mm) after 3 days implies better healing after 6 months. This effect was statistically significant, with a significance level of alpha = 5% (p = 0.0328). Regarding anal incontinence, women who received an episiotomy had fewer anal incontinence symptoms after 6 months. The effect of episiotomy was statistically significant, with a significance level of alpha = 5% (p = 0.0367).
TPUS is an accessible, non-invasive method for detecting, quantifying, following-up and monitoring OASIS in patients with third-degree perineal tears. The width, as obtained by sonography, is important with regard to the healing of OASIS. A mediolateral episiotomy seems to prevent anal incontinence after 6 months.
本研究旨在探讨经会阴超声（TPUS）是否可以确认或排除 OASIS 及其严重程度。本研究的另一个目的是在 6 个月的时间内监测愈合过程，并建立产科肛门括约肌损伤（OASIS）的超声表现与肛门失禁之间的联系。
在这项回顾性临床研究中，纳入了 2014 年 3 月至 2019 年 8 月间分娩时发生 OASIS 的患者。所有患者在分娩后 3 天和 6 个月时均接受 TPUS 检查。使用 GE E8 Voluson 超声系统和 3.5-5MHz 超声探头。超声图像显示为三度撕裂，测量撕裂的宽度及其严重程度（表浅、部分、完全、EAS 和 IAS 受累）。记录到收缩效应阳性，这是收缩充分的迹象。分娩 6 个月后，对愈合情况（愈合、疤痕或仍完全存在）进行超声评估。每位患者均获得 Wexner 评分。将患者的病史，包括年龄、产次、会阴切开术和孩子的体重添加到评估中。
在纳入的 55 名患者中，有 31 名患者纳入了统计评估。有 3 名患者因分娩后 3 天 TPUS 排除 OASIS 而被排除在统计评估之外。分娩后 9 天，1 名患者因超声评估显示肛门括约肌修复不当而接受了肛门失禁修复手术。由于其他原因，有 20 名患者被排除在外。结果表明，分娩后 3 天撕裂看起来更小（以毫米为单位）的患者，6 个月后愈合情况更好。这种效果具有统计学意义，显著性水平为 alpha=5%（p=0.0328）。关于肛门失禁，接受会阴切开术的女性在 6 个月后肛门失禁症状较少。会阴切开术的效果具有统计学意义，显著性水平为 alpha=5%（p=0.0367）。
TPUS 是一种易于获得、非侵入性的方法，可用于检测、量化、随访和监测三度会阴撕裂患者的 OASIS。通过超声获得的宽度对于 OASIS 的愈合很重要。中侧会阴切开术似乎可以预防 6 个月后的肛门失禁。
