Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal; Lisbon School of Medicine, Lisbon Academical Medical Center, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2022 Dec;279:140-145. doi: 10.1016/j.ejogrb.2022.09.033. Epub 2022 Sep 30.
Levator ani muscle (LAM) lesions are an important factor in the development of female pelvic organ prolapse (POP).
To determine the prevalence of LAM avulsion by transperineal ultrasound. The second outcome is to evaluate the association between complete avulsion and the type, degree, and number of POP compartments involved.
This was a retrospective cohort study performed in a tertiary hospital that included patients with pelvic floor dysfunction evaluated from January 2016 to March 2020. The presence of LAM avulsion was diagnosed by 3D/4D pelvic floor transperineal ultrasound. We identified women with POP, and they were classified according to the POP-Q system. The association between complete avulsion and the type, degree and number of compartments were calculated using generalized logit models.
848 women were included in the analysis. A complete LAM avulsion was found in 195 patients (23 %). Patients with complete avulsion were 4.7 (CI: 1.98-11.5) times more likely to have POP than patients with partial avulsion. The anterior compartment was the most frequently affected (n = 605, 25.8 %). Women with severe stage POP were 3.13 times (CI: 1.90-5.16) more likely to have bilateral complete LAM avulsion than women with mild prolapse. Patients with three-compartment POP were 2.75 times (CI: 1.53-4.94) more likely to have unilateral complete LAM avulsion than women with POP in one compartment.
The prevalence of LAM avulsion is high in patients with urogynecological symptoms. Patients with complete LAM avulsion are at greater risk of developing POP and have a more advanced stage of prolapse and involvement of multiple compartments.
肛提肌（LAM）损伤是女性盆腔器官脱垂（POP）发展的一个重要因素。
通过经会阴超声确定 LAM 撕裂的发生率。第二个结果是评估完全撕裂与涉及的 POP 隔室的类型、程度和数量之间的关系。
这是一项在一家三级医院进行的回顾性队列研究，纳入了 2016 年 1 月至 2020 年 3 月期间因盆底功能障碍而接受评估的患者。通过 3D/4D 盆底经会阴超声诊断 LAM 撕裂的存在。我们确定了患有 POP 的女性，并根据 POP-Q 系统对其进行分类。使用广义逻辑模型计算完全撕裂与隔室类型、程度和数量之间的关系。
共纳入 848 例女性。195 例（23%）患者存在完全 LAM 撕裂。与部分撕裂患者相比，完全撕裂患者发生 POP 的可能性高 4.7 倍（95%CI：1.98-11.5）。前隔室是最常受累的隔室（n=605，25.8%）。患有重度 POP 的女性双侧完全 LAM 撕裂的可能性是轻度脱垂女性的 3.13 倍（95%CI：1.90-5.16）。患有三隔室 POP 的女性发生单侧完全 LAM 撕裂的可能性是单隔室 POP 女性的 2.75 倍（95%CI：1.53-4.94）。
患有尿妇科症状的患者中 LAM 撕裂的发生率较高。完全 LAM 撕裂的患者发生 POP 的风险更高，脱垂程度更严重，且涉及多个隔室。
