改良阴道黏膜修补术在陈旧性产后会阴重度裂伤合并肛门失禁患者治疗中的应用

Application of modified vaginal mucosa repair in the treatment of old postpartum severe perineal laceration complicated with anal incontinence

目的 探讨改良阴道黏膜修补术在陈旧性产后会阴重度裂伤合并肛门失禁患者治疗中的应用价值。方法 选取2019年4月至2020年4月新疆医科大学第一附属医院肛肠科收治的80例陈旧性产后会阴重度裂伤合并肛门失禁的患者,按照随机数字表法分为对照组和改良组,各40例。对照组行会阴切口分层缝合术,改良组行改良阴道黏膜修补术。比较2组会阴切口愈合情况、Wexner失禁评分(WIS)、女性性功能指数(FSFI)量表评分以及简明健康状况调查量表(SF-36)评分。结果 术后3个月,改良组会阴切口总愈合率高于对照组[97.5%(39/40)比82.5%(33/40)],差异有统计学意义(P<0.05)。术前2组WIS、FSFI量表及SF-36各项评分比较差异均无统计学意义(均P>0.05)。术后1个月,2组WIS中大便次数、大便困难、排空不净感、腹痛、排便时间、协助排便、排便失败评分均低于术前,且改良组均低于对照组[(1.25±0.28)分比(1.87±1.26)分、(1.68±0.34)分比(2.01±0.67)分、(1.24±0.16)分比(1.58±0.67)分、(2.14±0.52)分比(2.75±1.02)分、(1.50±0.67)分比(1.91±0.35)分、(0.25±0.14)分比(0.46±0.37)分、(1.84±0.69)分比(2.18±0.48)分],差异均有统计学意义(P<0.05)。术后6个月,2组FSFI量表中性欲望、主观性唤起能力、性活动时阴道润滑性、性高潮、性生活满意度评分及总评分均高于术前,且改良组均高于观察组,性交痛评分均低于术前,且改良组低于对照组,差异均有统计学意义(均P<0.05)。术后6个月,2组SF-36中总体健康、躯体疼痛、活力、精神健康、生理功能、社会功能、情感智能、生理职能评分均高于术前,且改良组均高于对照组,差异均有统计学意义(均P<0.05)。结论 改良阴道黏膜修补术治疗陈旧性重度会阴裂伤合并肛门失禁效果显著,可有效改善肛门失禁情况,提高患者生活质量。

Objective To explore the application of modified vaginal mucosa repair in the treatment of old postpartum severe perineal laceration complicated with anal incontinence. Methods From April 2019 to April 2020, 80 patients with old postpartum severe perineal laceration complicated with anal incontinence admitted to the First Affiliated Hospital of Xinjiang Medical University were enrolled. They were randomly divided into control group and modified group, with 40 cases in each group. The control group was treated with layered suture of perineal incision, and the modified group was treated with modified vaginal mucosa repair. The healing of perineal incision, Wexner incontinence score(WIS), female sexual function indices(FSFI) scale score and brief health status survey scale(SF-36) score were compared between the two groups. Results Three months after surgery, the total healing rate of incision in the modified group was higher than that in the control group [97.5%(39/40) vs 82.5%(33/40)](P<0.05). There were no significant differences in WIS, FSFI scale and SF-36 scores between the two group before surgery(all P>0.05). One month after surgery, the scores of frequency of defecation, difficulty in defecation, feeling of unclean emptying, abdominal pain, defecation time, assisted defecation and defecation failure in WIS in both groups were lower than those before surgery, and those in the modified group were lower than those in the control group[(1.25±0.28) vs(1.87±1.26),(1.68±0.34) vs(2.01±0.67),(1.24±0.16) vs(1.58±0.67),(2.14±0.52) vs(2.75±1.02),(1.50±0.67)vs(1.91±0.35),(0.25±0.14) vs(0.46±0.37),(1.84±0.69) vs(2.18±0.48)](all P<0.05). Six months after surgery, the scores of sexual desire, subjective arousal ability, vaginal lubrication during sexual activity, orgasm, sexual life satisfaction and the total score in FSFI scale in both groups were higher than those before surgery, and the scores in the modified group were higher than those in the control group, the score of postoperative sexual intercourse pain in both groups was lower than that before surgery, and the score in the modified group was lower than that in the control group(all P<0.05). Six months after surgery, the scores of general health, somatic pain, vitality, mental health, physiological function, social function, emotional intelligence, physiological function in SF-36 in both groups were significantly higher than those before surgery and those in modified group were higher than those in the control group(all P<0.05). Conclusions Modified vaginal mucosa repair has a significant effect on the treatment of old postpartum severe perineal laceration complicated with anal incontinence. It can effectively improve the situation of anal incontinence and improve the living standards of patients.