回肠袋-直肠吻合术后的阴道分娩:一个警示

作     者：Remzi F.H. Gorgun E. Bast J. 张诗峰 

作者机构：Cleveland Clinic Foundation Department of Colorectal Surgery/A30 9500 Euclid Avenue Cleveland OH 44195 United States Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第2期

页      面：13-14页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

主　　题：回肠袋 直肠吻合术 阴道分娩 剖宫产分娩 整体生活质量 结肠切除术 结肠直肠 超声内镜检查 大便失禁 

摘      要：PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch- anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch- anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form- 36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade- off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique. RESULTS: Of 110 eligible females who had at least one live birth after ileal pouch- anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch- anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch- anal anastomosis (n = 20). The mean follow- up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent)vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg)after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade- off method also was significantly better