Women's and Children's Division, Leeds Teaching Hospital Trust, Beckett Street, LS9 7TF, Leeds, United Kingdom.
Airedale General Hospital, Skipton Road, Steeton, Keighley, BD20 6TD, United Kingdom.
Arch Gynecol Obstet. 2023 Nov;308(5):1399-1408. doi: 10.1007/s00404-023-06955-4. Epub 2023 Feb 21.
Levator ani muscle (LAM) avulsion affects up to 35% of women. Unlike obstetric anal sphincter injury, LAM avulsion is not diagnosed immediately after vaginal delivery, however, has a profound impact on quality of life. The management of pelvic floor disorders is in growing demand yet the significance of LAM avulsion in the context of pelvic floor dysfunction (PFD) is poorly understood. This study collates information on success of treatment for LAM avulsion to establish the best options for management of women.
MEDLINE, MEDLINE In-Process, EMBASE, PubMed, CINAHL and The Cochrane Library were searched for articles that evaluated the management techniques used to treat LAM avulsion. The protocol was registered with PROSPERO (CRD42021206427).
Natural healing of LAM avulsion occurs in 50% of women. Conservative measures, including pelvic floor exercises and pessary use are poorly studied. Pelvic floor muscle training for major LAM avulsions was of no benefit. Post-partum pessary use was only of benefit in the first three months for women. Surgeries for LAM avulsion are poorly researched but studies suggest they may provide benefit for 76-97% of patients.
Whilst some women with PFD secondary to LAM avulsion improve spontaneously, 50% continue to have pelvic floor symptoms 1 year following delivery. These symptoms result in a significant negative impact on quality of life, however, it is not clear whether conservative or surgical methods are helpful. There is a pressing need for research to find effective treatments and explore appropriate surgical repair techniques for women with LAM avulsion.
肛提肌（LAM）撕裂伤影响高达 35%的女性。与产科肛门括约肌损伤不同，LAM 撕裂伤并非在阴道分娩后立即诊断，但对生活质量有深远影响。对盆底障碍的管理需求不断增长，但 LAM 撕裂伤在盆底功能障碍（PFD）中的意义尚未得到充分理解。本研究收集了 LAM 撕裂伤治疗成功的信息，以确定治疗女性的最佳选择。
检索 MEDLINE、MEDLINE 正在处理、EMBASE、PubMed、CINAHL 和 Cochrane 图书馆，以评估用于治疗 LAM 撕裂伤的管理技术的文章。该方案已在 PROSPERO（CRD42021206427）中注册。
50%的女性 LAM 撕裂伤会自行愈合。保守治疗措施，包括盆底锻炼和使用子宫托，研究甚少。对于主要 LAM 撕裂伤，盆底肌肉训练没有益处。产后使用子宫托仅对女性前三个月有益。LAM 撕裂伤的手术研究甚少，但研究表明，76-97%的患者可能从中受益。
虽然一些因 LAM 撕裂伤引起的 PFD 女性会自发改善，但 50%的女性在分娩后 1 年仍有盆底症状。这些症状对生活质量产生了显著的负面影响，但尚不清楚保守治疗还是手术治疗更有帮助。迫切需要研究找到有效的治疗方法，并为 LAM 撕裂伤的女性探索合适的手术修复技术。
