产科相关肛门括约肌损伤57例临床特征及结局分析  

Analysis of clinical characteristics and outcomes of 57 cases with obstetric anal sphincter injuries.

作　　者：王乐乐 刘妍 周蓓 张慧珠 赖毓冕 刘慧姝 郑峥 WANG Le-le;LIU Yan;ZHOU Bei;ZHANG Hui-zhu;LAI Yu-mian;LIU Hui-shu;ZHENG Zheng(Department of Obstetrices and Gyne-cology,Guangzhou Women and Children’s Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心妇产科,广东广州510120

出　　处：《中国实用妇科与产科杂志》2024年第5期561-565,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省基础与应用基础粤穗联合青年基金(2020A1515110077)。

摘　　要：目的产科相关肛门括约肌损伤(obstetric anal sphincter injuries,OASIS)是严重的阴道分娩并发症。探讨发生OASIS人群的临床特点及围术期管理,为临床处置提供参考。方法回顾2018-01-01至2022-12-31在广州市妇女儿童医疗中心珠江新城院区阴道分娩过程中发生OASIS的病例,总结临床特点、围术期管理及修补术后随访结局。结果5年间OASIS发生率为0.1%(57/40855),会阴Ⅳ度裂伤占OASIS的21.1%(12/57)。初产妇占68.4%(39/57)。17.5%(10/57)为非枕前位分娩。会阴侧切率为38.6%(22/57)。阴道助产率为29.8%(17/57)。巨大儿仅4例,占7.0%(4/57)。有1例产后28d诊断直肠黏膜扣眼损伤,修补后随访至产后6个月,恢复良好。余56例为产时发现OASIS,肛门外括约肌端端缝合53例,重叠缝合3例。术后予肠道管理及广谱抗生素治疗。1例Ⅳ度裂伤患者发生直肠阴道瘘,保守治疗后瘘管自行愈合,其他患者均恢复良好。结论OASIS多发生于具有初产、阴道助产、非枕前位分娩、巨大儿等特征的孕妇。及时发现并规范的修补治疗以及围术期流程化管理是促进愈合的关键。Objective Obstetric anal sphincter injuries(OASIS)is a serious complication of vaginal delivery.This study aims to explore the clinical characteristics and perioperative management of patients with OASIS providing refer⁃ence for clinical management.Methods We reviewed the cases of OASIS during vaginal delivery at the Zhujiang New Town Branch of Guangzhou Women and Children's Medical Center from January 1,2018 to December 31,2022.We summarized the clinical characteristics,perioperative management,and follow-up outcomes.Results The 5-year inci⁃dence of OASIS was 0.1%(57/40855),with gradeⅣlaceration of the perineum accounting for 21.1%(12/57).Primip⁃ara accounted for 68.4%(39/57)of cases and 17.5%(10/57)were non-anterior occipital deliveries.The episiotomy rate was 38.6%(22/57),the assisted vaginal delivery rates was 29.8%(17/57)and only 4 cases were macrosomia,ac⁃counting for 7.0%(4/57).One rectal mucosal button-hole injury was diagnosed 28 days after delivery and followed up for six months after repair,resulting in a full recovery.56 cases were diagnosed with OASIS during labor,with 53 re⁃paired by external anal sphincter end-to-end and three repaired by overlapping.Postoperative intestinal management and broad-spectrum antibiotics were provided.One patient with a gradeⅣlaceration suffered a rectovaginal fistula,which healed spontaneously after three months of conservative treatment.The remaining patients recovered well.Conclu⁃sions OASIS often occurs in women with primiparity,vaginal delivery,non-occipital delivery,and macrosomia.Early detection,standardized repair treatment,and perioperative process management are key to successful healing.

关 键 词：产科相关肛门括约肌损伤 临床特征 围术期管理 临床结局 

分 类 号：R714.46[医药卫生—妇产科学]