Frudinger A, Bartram C I, Spencer J A, Kamm M A
St Mark's NHS Trust Hospital, Harrow.
Br J Obstet Gynaecol. 1997 Sep;104(9):1009-13. doi: 10.1111/j.1471-0528.1997.tb12058.x.
To assess the relation between perineal inspection and sphincter integrity in parous women.
Prospective observational study.
District general hospital.
Fifty-seven consecutive parous women attending a gynaecology clinic for problems unrelated to the pelvic floor.
A detailed history of bowel function and mode of delivery obtained; the perineum inspected to determine the presence and position of scarring, and anal endosonography performed.
In 19 women with an intact perineum on inspection, endosonography showed perineal scarring in five, with both perineal and sphincter scarring in three. Four had urge faecal incontinence. Three patients had a perineal tear only on inspection, but this group was too small for analysis and was discounted. Nine had an episiotomy scar only. Endosonography demonstrated perineal scarring in four, and combined perineal and sphincter scarring in two; one woman in this group had urge faecal incontinence. Twenty-six women had episiotomy and perineal tears on inspection. Endosonography revealed underlying perineal scarring in five women, with combined perineal and sphincter scarring in 14; six women in this group had urge faecal incontinence and one passive incontinence for flatus. Sonographically the scarring was anterior and circumferential rather than radial, and mostly left-sided, whereas on inspection episiotomy and perineal scarring were right sided.
A normal perineum on clinical examination does not exclude underlying sphincter damage. The incidence of sphincter damage increases significantly when an episiotomy scar is associated with a perineal tear.
评估经产妇会阴检查与括约肌完整性之间的关系。
前瞻性观察研究。
地区综合医院。
57名连续到妇科门诊就诊、问题与盆底无关的经产妇。
获取详细的排便功能和分娩方式病史；检查会阴以确定瘢痕的存在和位置，并进行肛门超声检查。
19名检查时会阴完整的女性中，超声检查显示5例会阴瘢痕形成，其中3例会阴和括约肌均有瘢痕形成。4例有急迫性大便失禁。3例仅在检查时有会阴撕裂，但该组样本量太小无法进行分析，故未纳入。9例仅有会阴侧切瘢痕。超声检查显示4例会阴瘢痕形成，2例会阴和括约肌联合瘢痕形成；该组1名女性有急迫性大便失禁。26名女性检查时有会阴侧切和会阴撕裂。超声检查发现5名女性存在潜在会阴瘢痕形成，14名有会阴和括约肌联合瘢痕形成；该组6名女性有急迫性大便失禁，1名有气体性被动失禁。超声检查显示瘢痕为前部和环形而非放射状，且大多在左侧，而检查时会阴侧切和会阴瘢痕在右侧。
临床检查会阴正常并不排除潜在的括约肌损伤。当会阴侧切瘢痕与会阴撕裂同时存在时，括约肌损伤的发生率显著增加。
