Samešová Adéla, Kiebooms Rafaël, Cattani Laura, Packet Bram, Williams Helena, Hympánová Lucie Hájková, Krofta Ladislav, Deprest Jan
Department Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.
The Institute for the Care of Mother and Child, Prague, Czech Republic.
Int Urogynecol J. 2025 Apr;36(4):749-757. doi: 10.1007/s00192-024-06034-5. Epub 2025 Jan 17.
Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth.
We systematically searched the PubMed, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and ICTRP databases from inception. We selected studies reporting on the anatomy of the LAM and ano-rectal function within 24 months after childbirth, the former determined by imaging and the latter measured through validated questionnaires or ano-rectal manometry. Meta-analyses were used to pool data from studies reporting on the association between LAM avulsion and ano-rectal function, with subgroup analysis according to the presence or absence of anal sphincter trauma. Summary odds ratio (OR) and mean difference (MD) are reported with 95% confidence intervals.
From the 7,621 studies identified, 11 were included, reporting on 2,146 women. Ten studies used transperineal ultrasound (TPUS) and one study used magnetic resonance imaging (MRI) for LAM assessment. Ano-rectal function was assessed through validated questionnaires in all but one study, in which ano-rectal manometry was used. There was no evidence for an association between LAM avulsion and symptoms of incontinence (OR 1.75 [0.74, 4.12]; MD 0.13 [-0.58, 0.85]), including in the subgroup of patients with concomitant anal sphincter injury (OR 1.83 [0.71, 4.71]).
We did not identify an association between LAM avulsion and ano-rectal dysfunction following vaginal childbirth.
妊娠和分娩通常与肛门直肠功能障碍相关。此外，阴道分娩可能会影响盆底的结构和功能。在此，我们系统回顾了文献，以探讨肛提肌（LAM）撕裂与产后肛门直肠功能之间的潜在关联。
我们从数据库创建之初就系统检索了PubMed、EMBASE、CINAHL、科学网核心合集、CENTRAL（Cochrane）、Clinicaltrials.gov和ICTRP数据库。我们选择了报告产后24个月内LAM解剖结构和肛门直肠功能的研究，前者通过影像学确定，后者通过经过验证的问卷或肛门直肠测压法测量。荟萃分析用于汇总报告LAM撕裂与肛门直肠功能之间关联的研究数据，并根据是否存在肛门括约肌损伤进行亚组分析。报告汇总比值比（OR）和平均差（MD）及其95%置信区间。
在检索到的7621项研究中，纳入了11项，涉及2146名女性。10项研究使用经会阴超声（TPUS）评估LAM，1项研究使用磁共振成像（MRI）。除1项研究使用肛门直肠测压法外，其余所有研究均通过经过验证的问卷评估肛门直肠功能。没有证据表明LAM撕裂与失禁症状之间存在关联（OR 1.75 [0.74, 4.12]；MD 0.13 [-0.58, 0.85]），包括在伴有肛门括约肌损伤的患者亚组中（OR 1.83 [0.71, 4.71]）。
我们未发现阴道分娩后LAM撕裂与肛门直肠功能障碍之间存在关联。
