The Effect Of Improved Perineal Reconstruction Combined With Anal Sphincter Repair In The Treatment Of OASIS

Objective: To explore the clinical effect of improved perineal reconstruction combined with anal sphincter repair for obstetric anal sphincter injury(OASIS).Methods: the clinical data of 20 patients with obstetric anal sphincter injury who underwent improved perineal reconstruction combined with anal sphincter repair in the First Hospital of Jilin University from October 2015 to September 2017 were retrospectively analyzed.The curative effect evaluation index including the general situation and patients before and after treatment of complications,the patient's subjective feelings(excellent grade: without any symptoms;good: dry and loose stools can control,but the anus or perineal discomfort during defecation occasionally;good: only dry stools can control;poor: the symptoms do not improve),a comparative study of Williams classification of patients before and after surgery(grade A~E,grade 2,the higher the grade,the worse ability to control it)and Wexner score(score range is 0~20,the higher the score,the worse ability to control it)and anorectal manometry and transrectal ultrasound ography.The time of follow-up was 6 months after the operation(March 2018).Results:(1)20 cases of female patients were successfully completed,the average operation time was 61(42~79)minutes,and the average postoperative hospital stay was 13(8~17)days.Postoperative complications: 20%(4/20)of incision pain,5% of anus distension(1/20),and 5%(1/20)of local necrosis of the flap.The local necrosis of skin flap healed by debridement and dressing for 2 months after operation,which did not affect the defecation function,and no serious complications such as infection or anal incontinence occurred after operation.After 6 months of follow-up,the total effective rate of subjective feeling was 100%(20/20).(2)20 cases of female patients,1 months after surgery,the subjective Williams grade compared with preoperative patients improved significantly,the difference was statistically significant(P<0.05),subjective Wexner score after 1 months and 6 months were 2.6±0.681 and 1.1±0.718,and the preoperative score(3.8±1.005)compared,the difference was statistically significant(P<0.05),6 months after the operation of anorectal dynamics objective and the testing parameters of preoperative control were improved,the maximum anal resting pressure(62.3±2.31 mm Hg)and preoperative(30.2±3.35 mm Hg)compared to the difference was statistically significant(P<0.05).The maximal anal contract pressure(144.9±4.65 mm Hg)was significantly different from that before operation(72.5±3.64 mm Hg)(P<0.05).Introrectal ultrasound showed that the sphincter of the anal sphincter was closely reclosed.Conclusions: Improved perineal reconstruction combined with anal sphincter repair is simple,safe and effective for the treatment of OASIS.