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| 번호 | 제목 | 등록일 | 조회수 |
|---|---|---|---|
| 75 | Is There Any Correlation Between Objective Anal Testing, Rupture Grade, and Bowel Symptoms After Primary Repair of Obstetric Anal Sphincter Rupture? [2002년 10월 DCR] | 2011-11-17 | 3454 |
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An Observational Cohort Study
Mohammad Nazir, M.D.,* Erik Carlsen, M.D., Ph.D.,* Anne Flem Jacobsen, M.D.,† Britt-Ingjerd Nesheim, M.D., Ph.D.†
From the *Department of Abdominal Surgery and †Department of Obstetrics, Ulleval University Hospital,
University of Oslo, Norway PURPOSE: The purpose of this study was to investigate the relationships between the grade of anal sphincter rupture, anal sphincter defect, manometry variables, and anal incontinence.
METHODS: A total of 132 females with first-time obstetric sphincter rupture were evaluated by transanal ultrasound, manometry, and scoring of bowel symptoms five months after delivery. RESULTS: Anal sphincter rupture and transanal ultrasound grade correlated with each other (rs = 0.427, P = 0.001). Both rupture and transanal ultrasound grade correlated with soiling grade (rs = 0.2, P =
0.03 for both), but in a multiple regression analysis, only transanal ultrasound grade was significant (P = 0.001) as an independent variable. Anal incontinence score correlated with all the manometry variables, but in a multiple regression analysis, only squeeze pressure was significant (P = 0.001, beta = -0.4) as an independent variable. Both anal sphincter rupture and transanal ultrasound grade were correlated with manometry variables, but only transanal ultrasound grade was significant as an independent variable after multiple regression analysis. The frequency of transanal ultrasound–verified extensive defect of anal sphincter was higher in rupture Grade 3B (25; 95 percent confidence interval, 12–38 percent) and Grade 4 (45; 95 percent confidence interval, 24–66 percent) than in Grade 3A (2.8; 95 percent confidence interval, -1 to -6.6 percent). CONCLUSION: Manometry variables are significantly lower in incontinent females than in continent females, and the Wexner incontinence score was correlated with manometry variables. Both anal sphincter rupture and transanal ultrasound grade correlated with soiling grade and with manometry variables, but in both cases only the transanal ultrasound grade was a significant independent variable.
Third-degree and fourth-degree perineal ruptures during vaginal delivery are associated with anal
incontinence in 20 to 60 percent of females. The reported frequency of transanal ultrasound (TAUS)– verified anal sphincter (AS) defect after primary repair of perineal rupture is 54 to 91 percent. There is disagreement about the correlation between anal incontinence, TAUS-verified AS defect, and anal manometry variables. The relationship between grade of perineal rupture and anal incontinence symptoms is also controversial. The number of females included in several of the reported studies is too small for meaningful comparisons between different groups. Therefore, we performed the present study with a larger group of females who had either complete or partial AS rupture. |
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