产后至少一年产科肛门括约肌损伤(OASI)后长期盆底症状的评估:一项159例回顾性队列研究

Gynecologie Obstetrique & Fertilite Pub Date : 2016-07-01 DOI:10.1016/j.gyobfe.2016.05.007

D. Desseauve , S. Proust , C. Carlier-Guerin , C. Rutten , F. Pierre , X. Fritel

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引用次数: 27

摘要

目的本研究的目的是评估产科肛门括约肌损伤(OASI)后的长期盆底症状。方法回顾性队列研究纳入2000年至2011年在普瓦捷大学医院确诊的237例OASI病例(占分娩的0.86%)。采用有效的自我管理问卷对症状进行评估，包括女性盆底问卷、Pescatori肛门失禁评分、EuroQoL五维评分和疼痛视觉模拟量表(VAS)。结果160名妇女(67%)在分娩后平均46个月(8 ~ 152)填写了问卷。其中93例(54%)报告至少有一种症状“经常”发生(最常见的是性交困难)，45例(28%)报告至少有一种症状“每天”发生(最常见的是肠胃失禁)。肛门失禁32例(20%)，肠胃失禁28例(18%)，大便失禁“经常”或“每天”9例(6%)。27名女性(17%)在压力下“经常”或“每天”出现尿失禁，17名(11%)在冲动下，11名(7%)在混合情况下。6名妇女(4%)“经常”或“每天”报告脱垂症状。17名女性(11%)报告性交时“经常”或“每天”疼痛。24名女性(18%)报告慢性盆腔疼痛(VAS评分≥4/10)。95%的女性报告在行动能力、自我照顾和日常活动方面的生活质量正常;然而，疼痛/不适(32%)和焦虑/抑郁(33%)领域的改变经常被报道。结论OASI术后4年盆底症状高发。

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Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases

Objectives

The aim of this study was to assess long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI).

Methods

This retrospective cohort study included 237 cases of OASI (0.86% of deliveries) identified at Poitiers University Hospital between 2000 and 2011. Symptoms were assessed using validated self-administered questionnaires, including Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale (VAS).

Results

One hundred and sixty women (67%) filled out the questionnaires, on average 46 months after delivery (8–152). Among them, 93 (54%) reported at least one symptom occurring “frequently” (the most common being dyspareunia), and 45 (28%) a symptom occurring “daily” (the most common being flatus incontinence). Anal incontinence was reported by 32 (20%) women, flatus incontinence “frequently” or “daily” by 28 (18%), and stool incontinence “frequently” or “daily” by 9 (6%). Urinary incontinence was reported “frequently” or “daily” by 27 women (17%) at stress, 17 (11%) at urge, and 11 (7%) at mixed circumstances. Prolapse symptoms were reported “frequently” or “daily” by 6 women (4%). Pain during intercourse was reported “frequently” or “daily” by 17 women (11%). Twenty-four women (18%) reported chronic pelvic pain (VAS score ≥ 4/10). Ninety-five percent of women reported a normal quality of life for mobility, self-care, and usual activities; however, alterations in pain/discomfort (32%) and anxiety/depression (33%) domains were frequently reported.