회음부 손상에 의한 변실금 환자에서 해부학적 복원 수술의 결과 및 수술 전 예측인자
Outcome and Preoperative Predictive Factor after Complete Anatomical Repair in Perineal Obstetric Injury
박덕훈, 윤서구, 이종호, 윤종섭, 류재현, 이종균, 김광연,
소속 상세정보
박덕훈 ( Park Duk-Hoon )
송도병원 외과
윤서구 ( Yoon Seo-Gu )
송도병원 외과
이종호 ( Lee Jong-Ho )
송도병원 외과
윤종섭 ( Yoon Jong-Sub )
송도병원 외과
류재현 ( Ryu Jae-Hyun )
송도병원 외과
이종균 ( Lee Jong-Kyun )
송도병원 외과
김광연 ( Kim Kwang-Yeon )
송도병원 외과
KMID : 0356720020180040222
Abstract
Purpose: To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury.
Methods: Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9±10.1 years, mean duration of symptom was 18.9 (range: 1∼33) years, mean delivery numbers were 2.8±1.2 times, and mean follow up was 11.9±4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex),duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner’s incontinence score.
Results: The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners’ score≤5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (P＜0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (P＜0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017).
Conclusions: Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.
키워드
변실금;분만손상;해부학적 복원술
Fecal incontinence;Obstetric injury;Anatomical repair
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