三度和四度产科肛门括约肌损伤的延迟二期修复：重叠式与端端括约肌修复术的随机对照试验
Delayed secondary repair of third- and fourth-degree obstetric anal sphincter injuries: a randomized controlled trial comparing overlapping versus end-to-end sphincter repair.
摘要(中文译文)
继发性肛门括约肌修补在产科肛门括约肌损伤（OASI）初次修补后需要进行的病例中不足3%。尽管越来越多的证据对早期与延迟继发性修补进行了比较，但继发性OASI的传统且最常见的处理方式仍是延迟修补。本研究比较了在OASI延迟继发性修补中重叠式与端端括约肌修补技术的临床和功能结局。在这项单中心随机对照试验中，40例初次修补后发生Ⅲ度或Ⅳ度OASI且伤口裂开的女性按1：1随机分配至重叠式括约肌成形术或端端对合术。评估在术前及术后2周、3、6和12个月进行。主要结局为12个月时的Wexner失禁评分。分析采用符合方案集分析，并进行意向性治疗敏感性分析。38例女性纳入符合方案集分析（重叠式组n=18；端端组n=20）。重叠式组有2例患者失访。重叠式组的手术时间显著更长（121.3±5.5 vs 102.8±6.3分钟；p<0.001）。重叠式修补导致平均Wexner评分显著更低（0.5±0.2 vs 2.2±0.8；p<0.001），完全控便率更高（Wexner≤5：100% vs 85%；p=0.03）。重叠式组伤口愈合时间更短（23.3±4.8 vs 26.9±5.5天；p=0.08），总体并发症更低（11.1% vs 30.0%）。肛内超声Starck评分和测压参数显示出一致倾向于重叠式修补的趋势，尽管这些差异无统计学意义。在延迟继发性OASI修补中，当结合细致的肌肉游离和标准化术后方案时，重叠式括约肌成形术较端端修补提供更优的控便结局和更低的并发症率。这些发现支持将重叠式修补作为该情形下的首选技术。
Abstract
Secondary anal sphincter repair is necessary in fewer than 3% of cases following primary repair of obstetric anal sphincter injuries (OASI). Although there is some growing evidence comparing early and delayed secondary repairs, the traditional and most common way to manage secondary OASI is still delayed repair. This study compared clinical and functional outcomes of overlapping versus end-to-end sphincter repair techniques in delayed secondary repair of OASI. In this single-center randomized controlled trial, 40 women with third- or fourth-degree OASI and wound dehiscence after primary repair were randomized 1:1 to overlapping sphincteroplasty or end-to-end approximation. Assessments were performed preoperatively and at 2 weeks, 3, 6, and 12 months. The primary outcome was the Wexner incontinence score at 12 months. Analysis was per-protocol with intention-to-treat sensitivity analysis. Thirty-eight women were included in the per-protocol analysis (overlapping n = 18; end-to-end n = 20). Two patients in the overlapping group were lost to follow-up. Operative time was significantly longer in the overlapping group (121.3 ± 5.5 vs 102.8 ± 6.3 min; p < 0.001). The overlapping repair resulted in a significantly lower mean Wexner score (0.5 ± 0.2 vs 2.2 ± 0.8; p < 0.001) and higher rate of complete continence (Wexner ≤ 5: 100% vs 85%; p = 0.03). Time to wound healing was shorter (23.3 ± 4.8 vs 26.9 ± 5.5 days; p = 0.08) and overall complications were lower (11.1% vs 30.0%) in the overlapping group. Endoanal ultrasound Starck scores and manometry parameters showed consistent trends favoring overlapping repair, although these differences were not statistically significant. In delayed secondary OASI repair, overlapping sphincteroplasty provided superior continence outcomes and lower complication rates than end-to-end repair, when combined with meticulous muscle mobilization and a standardized postoperative regimen. These findings support overlapping repair as the preferred technique in this setting.
如何引用
AMA
P B A Awad, B H A Hassan, D M Hanafy, A A Abdelshafy, M A M Nada. Delayed secondary repair of third- and fourth-degree obstetric anal sphincter injuries: a randomized controlled trial comparing overlapping versus end-to-end sphincter repair.. Techniques in coloproctology. 2026; doi:10.1007/s10151-026-03362-0.
APA
P B A Awad, B H A Hassan, D M Hanafy, A A Abdelshafy, M A M Nada (2026). Delayed secondary repair of third- and fourth-degree obstetric anal sphincter injuries: a randomized controlled trial comparing overlapping versus end-to-end sphincter repair.. Techniques in coloproctology. https://doi.org/10.1007/s10151-026-03362-0
GB/T 7714
P B A Awad, B H A Hassan, D M Hanafy, A A Abdelshafy, M A M Nada. Delayed secondary repair of third- and fourth-degree obstetric anal sphincter injuries: a randomized controlled trial comparing overlapping versus end-to-end sphincter repair.[J]. Techniques in coloproctology, 2026 doi:10.1007/s10151-026-03362-0.
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