Walsh C J, Mooney E F, Upton G J, Motson R W
Department of Surgery, Colchester General Hospital, Essex.
Br J Surg. 1996 Feb;83(2):218-21.
The incidence and outcome of third-degree tears following 16,583 vaginal deliveries were prospectively assessed over a 5.5-year period. Ninety-three deliveries (0.56 per cent) were complicated by a third-degree tear and the patients underwent primary repair. Eighty-one patients were reviewed 3 months postpartum at a colorectal clinic. Third-degree tears were significantly more common in primigravidae and mothers with higher birth-weight babies. They were significantly associated with the use of forceps and were not prevented by episiotomy. Of the 81 patients reviewed, 30 had an abnormal anorectal examination. Six patients (7 per cent) were incontinent of faeces. A further ten (12 per cent) were incontinent of flatus only. The overall incidence of faecal incontinence was 0.04 per cent. An important group of women with significant subclinical sphincter injury was identified. Obstetric trauma causes significant anorectal dysfunction and patients with third-degree tears require assessment by a colorectal specialist.
在5.5年的时间里，对16583例阴道分娩后三度撕裂伤的发生率和结局进行了前瞻性评估。93例分娩（0.56%）并发三度撕裂伤，患者接受了一期修复。81例患者在产后3个月到结直肠诊所接受复查。三度撕裂伤在初产妇和分娩体重较大婴儿的母亲中明显更为常见。它们与产钳使用显著相关，会阴切开术并不能预防。在接受复查的81例患者中，30例肛门直肠检查异常。6例患者（7%）大便失禁。另有10例患者（12%）仅排气失禁。大便失禁的总体发生率为0.04%。确定了一组存在明显亚临床括约肌损伤的重要女性群体。产科创伤会导致严重的肛门直肠功能障碍，三度撕裂伤患者需要结直肠专科医生进行评估。
