Levatoranimusclemorphologyandfunctioninwomenwithobstetricanalsphincterinjury產(chǎn)時(shí)肛門括約肌損傷婦女肛提肌形態(tài)及功能Approximately,oneoutoffivewomenwillundergosurgicalrepairforpelvicorganprolapseduringtheirlifetime.約1/5的婦女一生中會(huì)接受盆腔器官脫垂修復(fù)手術(shù)Levatoraniavulsionisasignificantriskfactorforpelvicorganprolapsewhichcanbedetectedbypalpation,ultrasoundorMRI.肛提肌撕裂是盆腔器官脫垂的重要風(fēng)險(xiǎn)因素，通過觸診、超聲、MRI發(fā)現(xiàn)However,itiscontroversialwhetherlevatoraniavulsionisalsoariskfactorforurinaryoranalincontinence.而肛提肌撕裂是否為尿失禁或糞失禁的高危因素存在爭議INTRODUCTION介紹~%20Obstetricanalsphincterinjury(OASI)canbediagnosedafterdeliveryviapalpationwhereasmostlevatoraniavulsionsareoccult.

產(chǎn)時(shí)肛門括約肌損傷（OASI）可在產(chǎn)后通過觸診診斷，而大多數(shù)肛提肌損傷是隱匿性的INTRODUCTION

介紹Levatoranimuscle(LAM)avulsion肛提肌撕裂Analsphincterinjury肛門括約肌損傷TheprimaryaimofthisstudywastoestimatetheprevalenceofmajorLAMinjuryinwomenwithclinicallydiagnosedOASIandtoexploretheriskfactorsassociatedwithLAMinjury.本研究主要目的是評估臨床上診斷為OASI的婦女中肛提肌撕裂的發(fā)生率，探討肛提肌損傷相關(guān)的風(fēng)險(xiǎn)因素ThesecondaryaimwastoassesstheassociationbetweenLAMinjuryandpelvicfloormusclecontraction,analincontinence(AI)andurinaryincontinence(UI)inwomenwithOASI.另外的目的是評價(jià)肛提肌損傷與盆底肌肉收縮、糞失禁及尿失禁的相關(guān)性(n=250)WomenreferredtoCroydonUniversityHospitalbetween2013and2015withaclinicaldiagnosisofOASIwereincludedinthestudy.Includedwomenwereevaluatedvia:2013-2015年因診斷為OASI轉(zhuǎn)診至Croydon大學(xué)醫(yī)院的婦女納入本研究，并通過下列方法進(jìn)行評價(jià)Clinicalhistory臨床病史Analincontinence-St.Mark’sincontinencescore糞失禁-St.Mark’s失禁評分Urinaryincontinence–ICIQ-UI-SF尿失禁-ICIQ-UI-SFPelvicmusclestrength-ModifiedOxfordScale盆底肌力-改良Oxford量表LAMintegrity–transperineal4Dultrasound肛提肌完整性-經(jīng)會(huì)陰4D超聲METHODS方法Atthetimeofevaluation,88(35.2%)womenwerepregnantagain.進(jìn)行評估時(shí)，88例（35.2%）婦女再次妊娠Themediantimeintervalbetweenlastpregnancyandevaluationwas5months.末次妊娠距評估間隔時(shí)間中位數(shù)為5個(gè)月Twowomenwereexcludedfromanalysisduetoartifactsinthesavedimagevolumes(levatormusclewasassessedin248ultrasoundvolumes).排除了存儲(chǔ)圖像容積有偽像的2例（248個(gè)超聲容積數(shù)據(jù)中評價(jià)了肛提?。㏑ESULTS結(jié)果MajorLAMavulsion肛提肌明顯撕裂

(73/248,29.4%)IntactLAM肛提肌完整(177/248,70.6%)Evaluatedwith4Dtransperinealultrasonography使用經(jīng)會(huì)陰4D超聲評價(jià)Unilateral單側(cè)(49/248,19.8%)Bilateral雙側(cè)(24/248,9.7%)RESULTSRESULTS結(jié)果FactorsassociatedwithmajorLAMavulsion(univariateanalysis)肛提肌明顯撕裂相關(guān)因素（單因素分析）PreviousoperativedeliveryincreasedsignificantlytheoddsofmajorLAMavulsionalongwithobesityintheunivariateanalysis在單因素分析中手術(shù)產(chǎn)及肥胖明顯增高了肛提肌明顯撕裂的幾率P<0.05因素手術(shù)產(chǎn)胎吸產(chǎn)鉗胎吸+產(chǎn)鉗3c+4級撕裂風(fēng)險(xiǎn)減低風(fēng)險(xiǎn)增高RESULTS結(jié)果FactorsassociatedwithmajorLAMavulsion(multivariableanalysis)肛提肌明顯撕裂的相關(guān)因素（多因素分析）Previousoperativedelivery(forceps)andlowerBMIremainedassignificantriskfactorsformajorLAMavulsion.手術(shù)產(chǎn)（產(chǎn)鉗）及BMI減低是肛提肌明顯撕裂有意義的風(fēng)險(xiǎn)因素Womenwithpreviousoperativedeliveryhad4.1timesincreasedoddsofmajorLAMavulsion.有手術(shù)產(chǎn)史的婦女發(fā)生肛提肌明顯撕裂的幾率升高4.1倍One-pointincreaseinBMIwasassociatedwitha10%reducedriskofmajorLAMavulsion.

BMI增長一個(gè)點(diǎn)，肛提肌明顯撕裂的風(fēng)險(xiǎn)減少10%RESULTS結(jié)果WomenwithmajorLAMavulsionhadweakerpelvicmusclecontractioninbothdigitalandultrasoundexamination.指檢和超聲檢查均顯示肛提肌明顯撕裂的婦女肌力減低However,majorLAMavulsionwasnotassociatedwithanincreasedseverityofanalorurinaryincontinencesymptoms.而肛提肌明顯撕裂與糞失禁和尿失禁癥狀嚴(yán)重程度并不相關(guān)DISCUSSION討論Inthisstudy,operativevaginaldeliverywasassociatedwithafour-foldhigherriskofLAMinjurythanwasnormalvaginaldelivery.此研究中手術(shù)助產(chǎn)的陰道分娩較正常陰道分娩與肛提肌損傷風(fēng)險(xiǎn)增高4倍相關(guān)WomenwithmajorLAMinjuryhadweakerpelvicfloormusclecontractionasassessedbypalpationandonultrasound.指檢和超聲評價(jià)顯示肛提肌明顯損傷的婦女盆底肌收縮弱NoassociationbetweenLAMinjuryandAIorUI,andnoassociationbetweenmusclecontractionandincontinenceweredemonstrated.肛提肌損傷與糞失禁或尿失禁無相關(guān)性，肌肉收縮與失禁無相關(guān)POINTSFORDISCUSSION討論重點(diǎn)TheeffectofmajorLAMavulsionsonincontinencesymptomsinelderlywomen.肛提肌明顯損傷對老年婦女失禁癥狀的影響Possibleimplicationsofuniversal