Occult anal sphincter injuries - myth or reality?
Occult anal sphincter injuries - myth or reality?
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DOI：
10.1111/j.1471-0528.2006.00799.x
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发表时间：
2006-02-01
影响因子：
5.8
通讯作者：
Jones, PW
中科院分区：
文献类型：
--
作者：
Andrews, V;Sultan, AH;Jones, PW
目的了解临床上可识别和隐匿性产科肛门括约肌损伤（OASIS）的真实患病率。设计前瞻性干预研究。设置忙碌区总医院。样本254名妇女有他们的第一次阴道分娩超过12个月的时间被邀请。241例（95%）参与，208例（86%）参加随访。方法产妇分娩时由产科医生进行临床检查，产后由有经验的研究人员进行复查。所有确定的OASIS都由值班专家登记员或顾问进行了核实和维修。产后立即进行肛内超声检查，7周后重复。主要观察指标：公认的和隐匿性肛门括约肌损伤的患病率。结果59例（24.5%）患者发生OASIS。OASIS的患病率显着增加，从11%到24.5%时，妇女进行了重新检查。其中，30例发生在助产士的分娩中，漏诊了26例（87%），29例发生在医生的分娩中，漏诊了8例（28%）。所有临床上明显的OASIS也通过肛门内超声确定。此外，3名（1.2%）女性有隐匿性肛门括约肌损伤。其中两例隐匿性括约肌损伤与肛门内括约肌（IAS）分离，通常临床上无法检测到。结论OASIS的发生率高于以往报道。许多仍然未确诊，随后被归类为隐匿性时，确定肛门超声内镜。真正的隐性损伤是罕见的。需要加强会阴解剖学和OASIS识别方面的培训，以提高OASIS的检出率并最大限度地降低随后发生肛门失禁的风险。
Objectives To establish the true prevalence of clinically recognisable and occult obstetric anal sphincter injuries (OASIS). Design Prospective interventional study. Settings Busy district general hospital. Sample Two hundred and fifty-four women having their first vaginal delivery over a 12-month period were invited. Two hundred and forty-one (95%) participated and 208 (86%) attended follow up. Methods Women had a clinical examination at delivery by the accoucheur and repeated by an experienced research fellow immediately after delivery. All identified OASIS were verified and repaired by the duty specialist registrar or consultant. Endoanal ultrasound was performed immediately postpartum prior to suturing and repeated seven weeks later. Main outcome measures Prevalence of recognised and occult anal sphincter injuries. Results Fifty-nine (24.5%) women sustained OASIS. The prevalence of OASIS increased significantly from 11% to 24.5% when women were re-examined. Of these, 30 occurred in deliveries by midwives who missed 26 (87%) and 29 following deliveries by doctors who missed 8 (28%) injuries. All clinically apparent OASIS were also identified on endoanal ultrasound. In addition, three (1.2%) women had an occult anal sphincter injury. Two of these occult sphincter injuries were isolated to the internal anal sphincter (IAS) and would not usually be clinically detectable. Conclusions OASIS occur more frequently than previously reported. Many remain undiagnosed and are subsequently classified as occult when identified on anal endosonography. Genuine occult injuries are rare. Training in perineal anatomy and recognition of OASIS needs to be enhanced in order to increase detection of OASIS and minimise the risk of consequent anal incontinence.