Sultan A H, Kamm M A, Bartram C I, Hudson C N
St. Bartholomew's Hospital (Homerton), West Smithfield, London, UK.
Int J Gynaecol Obstet. 1993 Dec;43(3):263-70. doi: 10.1016/0020-7292(93)90514-w.
To determine the incidence of defecatory symptoms, pudendal nerve damage and mechanical trauma to the anal sphincters during vacuum and forceps delivery.
Anal endosonography, manometry, pudendal nerve terminal motor latency (PNTML) measurements and perineometry were performed in 43 primiparae who had an instrumental delivery (17 vacuum and 26 forceps) and in 47 who had a normal vaginal delivery (controls).
Defecatory symptoms developed in 10 (38%) women following a forceps delivery compared with 2 (4%) in the control group (P = 0.0003), and 2 (12%) following a vacuum extraction (P = NS). Anal sphincter defects occurred in 21 (81%) forceps deliveries compared with 17 (36%) controls (P = 0.0005) and 4 (21%) vacuum extractions (P = NS). Anal pressures were lower in those who developed a sphincter defect (P < 0.00001). PNTML was not significantly altered by the mode of delivery.
Compared with vacuum extraction, forceps delivery is associated with significantly more damage to the anal sphincters and hence an increased incidence of defecatory symptoms.
确定真空吸引和产钳助产分娩过程中排便症状、阴部神经损伤及肛门括约肌机械性损伤的发生率。
对43例经器械助产分娩（17例真空吸引和26例产钳助产）的初产妇及47例正常阴道分娩的产妇（对照组）进行肛门腔内超声检查、测压、阴部神经终末运动潜伏期（PNTML）测量及会阴测压。
产钳助产分娩后10例（38%）产妇出现排便症状，而对照组为2例（4%）（P = 0.0003）；真空吸引助产分娩后有2例（12%）出现排便症状（P =无显著性差异）。产钳助产分娩中有21例（81%）发生肛门括约肌损伤，而对照组为17例（36%）（P = 0.0005），真空吸引助产分娩中有4例（21%）发生损伤（P =无显著性差异）。发生括约肌损伤者的肛门压力较低（P < 0.00001）。分娩方式对PNTML无显著影响。
与真空吸引助产相比，产钳助产分娩对肛门括约肌的损伤明显更多，因此排便症状的发生率增加。
