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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1447_Библиотеки_им_академика_М_И_Перельмана.pdf
192 Index
Flatus
diet-related, 136
differential diagnosis of, 144
differentiated from faeces, 114
Forceps delivery, 53, 58–59
as perineal trauma cause, 34,
56–57
versus vacuum extraction, 58–59
G
Gastrointestinal tract, embryonic
development of, 1–3
Gastrointestinal transit studies,
104, 111
Gluteoplasty, bilateral
unstimulated, 157–158
Graciloplasty, stimulated, 158–159,
162, 163
H
Haemorrhoidal artery, 8–9
Haemorrhoidal nerve, 11
Haemorrhoidectomy, as faecal
soiling cause, 90
Haemorrhoids
as anal incontinence cause, 133
postpartum, 69–70
during pregnancy, 69, 70
prolapsing, 90
Hematomas, perineal postpartum,
67
Hysterectomy, rectovaginal fi stula
formation after, 167, 170
I
Iliococcygeus muscle
anatomy of, 9–10, 90
innervation of, 11
Infl ammatory bowel disease, 136
as anal fi ssure cause, 68
as anal incontinence cause, 133
as fecal incontinence cause, 144
Informed consent, 16, 103
Internal anal sphincter
anatomy of, 6, 7, 8, 16, 17, 38
appearance of, 38
examination of, 16, 17
innervation of, 8
location of, 38
role in bowel continence, 91
rupture of, 106
sonographic anatomy of,
124–125, 126
sonographic defects of, 17–18
thickness of, 131
vaginal delivery-related injuries
to diffi culty of repair of,
146, 150
end-to-end repair of, 36
repair of, 38, 146, 150, 151
repair outcome in, 151
repair techniques for, 150
sonographic imaging of,
128–129, 130
suture repair of, 33
undiagnosed tears, 17–18
Irritable bowel syndrome, 136
as anal incontinence cause, 133
effect on anal sphincter repair
outcome, 146–147, 152
as faecal incontinence cause,
144
Ischioanal (ischiorectal) fossa, 9
Ischiocavernous muscle, 4, 5
Ischiococcygeus muscle
anatomy of, 9, 10
innervation of, 11
L
Labia
fusion of, 74
laceration repair of, 28
Labor
position during
occipito-posterior, 34
for perineal trauma
prevention, 53, 55–56
second-stage
duration of, 61
genital mutilation reversal
during, 85
pushing during, 53, 56
Lactose intolerance, 136
Laxatives, 69, 139
Levator ani muscles
anatomy of, 6, 9–10
contraction evaluation of, 115
embryonic development of, 3
innervation of, 11
obstetric injuries to, 129
sonographic anatomy of, 125
vascular supply to, 11
Levator ani nerve, 11
Levatorplasty, 36, 154
Longitudinal coat, conjoint, 6, 8, 9
Longitudinal layer, 6, 8
sonographic anatomy of, 124
Loperamide, 139, 145
M
Magnetic resonance imaging (MRI)
endocoil, of obstetric anal
sphincter injuries, 129
of striated muscle atrophy,
130–131
Malpractice claims
American perspective on,
183–187
British perspective on, 178–183
negligence basis for, 178
Manometry, anorectal
for faecal incontinence
evaluation, 102–103,
104–110
ambulatory, 116
anal sphincter functional
assessment in, 104–108
balloon expulsion test in, 104,
110
rectal compliance assessment
in, 104, 109–110
rectal sensation assessment
in, 104, 108–109
rectoanal pressure
relationships assessment in,
104–108, 109–110
rectoanal refl ex activity
assessment in, 104, 108
saline continence test in, 104,
110
vector volume (vectograph),
116, 117
of obstetric anal sphincter
injuries (OASIS), 43, 44
for postpartum anal sphincter
function evaluation, 93–94
of rectal/colonic motor
complexes, 92–93
Maximal voluntary anal squeeze
pressure, 105, 106, 107–108
Maximal voluntary increment anal
squeeze pressure, 105, 107
Mayday University Hospital,
Perineal Clinic, 75–76
Medicolegal issues
female genital mutilation,
86–87
malpractice claims
American perspective on,
183–187
British perspective on,
178–183
negligence basis for, 178
Index 193
Megarectum, 92
Midwives, perineal trauma repair
by, 21–22
N
Neuropathy, pudendal, 112, 113
as contraindication to anal
sphincter repair, 149
effect on anal sphincter repair
outcome, 145–147
evaluation of, 96, 112, 113, 114,
145–146
Neurophysiological studies, of
anorectal function, 103,
112–114
Nonsteroidal anti-infl ammatory
drugs, as perineal pain
treatment, 66, 67
O
Obesity, as faecal incontinence risk
factor, 133, 135
Obstetric anal sphincter injuries
(OASIS), 33–51, 94–95
“buttonhole” rectal tears and,
13, 15, 16, 37–38, 162, 163
classifi cation/grading of, 13, 14,
15, 37
fi rst-degree tears, 14
fourth-degree tears, 13, 14, 16
occult, 17–18, 128, 130, 144,
169
second-degree tears, 13, 14
third-degree tears, 13, 14, 16
as defects, 128
diagnosis of, 16–19
episiotomy-related, 57–58
perineal clinic-based treatment
of, 76
primary repair of
education and training in,
46–47, 48
end-to-end technique in, 34,
36–37, 40, 48
historical perspective on, 33
outcome of, 34, 35
overlap technique in, 34,
36–37, 39, 40, 48
postoperative management of,
40–42
principles and techniques of,
37–40
rectovaginal fi stula-associated,
169
with rectovaginal septal injury,
145
recurrence of, 43, 61
sonographic imaging of,
128–129
subsequent pregnancies after,
43
Opiates, as perineal pain
treatment, 66
P
Pelvic fl oor
anatomy of, 9–11
descent during defaecation,
115
innervation of, 91–92
musculature of, 90
obstetric injury to, 74
Pelvic fl oor exercises, 55, 73, 140
Pelvic organ prolapse, 74–75
Perineal body
anatomy of, 4, 9
sonographic anatomy of, 125
thickness measurement of,
129–130
Perineal massage, antenatal, 53,
54–55
Perineal membrane, 5
Perineal nerve, 11–12
Perineal obstetric injuries, 33–51.
See also Obstetric anal
sphincter injuries (OASIS),
33–51
anterior, 21
classifi cation/grading of, 13–15,
21
fi rst- and second-degree tears,
20–32
fourth-degree tears, 33
complications of, 52
defi nition of, 21
diagnosis of, 13–19
historical perspective on, 33
objective assessment of, 15–16
as perineal pain cause, 65–67
posterior, 21
prevalence of, 13, 21
previous vaginal delivery-
related, 61
as rectovaginal fi stula cause,
167, 169–170
repair of
basic surgical principles for,
27–28
continuous suture technique
in, 24–26, 28–30
of episiotomy, 28
of fi rst- and second-degree
tears, 28
of fourth-degree tears, 33
of labial lacerations, 28
non-suturing approach in,
23
non-suturing of perineal skin
in, 23–24
performed by midwives,
21–22
perineal skin closure in, 24,
29–30
suture materials for, 26–27
suturing techniques in,
23–27
of third- and fourth-degree
tears, 22
training for, 21–22
risk factors for, 61
strategies for prevention of,
52–62
randomized controlled trials
of, 52–59
unproven, 53, 59–61
Perineal pain, 20
effect of perineal suturing on,
24–26
postpartum, 65–67, 74
Perineal stretching massage, 53,
58
Perineometry, 115
Perineotomy, 21
Perineum
anatomy of, 3, 21
anesthetization of, 5
descent during defaecation,
115
length of, as anal sphincter
trauma risk factor, 61
musculature of, 3–9
Peri-Rule, 15–16
Pessaries, vaginal, 75, 170
Phenylephrine, 139
Planimetry, impedance, 116
“Porridge continence test,” 115
Postpartum health problems,
65–79
Pregnancy, genital mutilation
reversal during, 85–86
Probiotics, 136
Proctoderm, 1
194 Index
Proctography
evacuation, 103, 110, 114–115
for rectocele diagnosis, 145
Puboanalis muscle, obstetric
injuries to, 129
Pubococcygeus muscle, anatomy
of, 9, 10, 90
Puboperineal muscle, 10
Puborectalis muscle
anatomy of, 3, 8, 10, 90, 91
in defaecation, 93
relationship to external anal
sphincter, 1
sonographic anatomy of, 125
Pudendal arteries, 8–9, 11–12
Pudendal nerve, 91
anatomy of, 9, 11
injury to
as incontinence cause, 92, 96
vaginal delivery-related, 96
pathways of, 5, 7
role in anocutaneous refl ex,
115
Pudendal nerve terminal motor
latency
defi nition of, 96
evaluation of, 96, 112, 113, 114,
145–146
with clitoral-anal refl ex test,
115–116
technique of, 96, 112
R
Radiation therapy, as rectovaginal
fi stula cause, 170
Radio-opaque marker studies, of
constipation, 111
Rectal compliance, 92, 109–110
barostat studies of, 109, 110–111
impaired, 92
Rectal examination
digital, 104
for faecal incontinence
evaluation, 104
guidelines for, 16
in perineal obstetric trauma, 28
Rectal prolapse, 112, 135
Rectal sensory function
assessment, 103, 114
barostat studies of, 109,
110–111
manometric, 104, 108–109
Rectoanal contractile refl ex, 91
Rectoanal inhibitory refl ex, 108
Rectoanal pressure gradient, 91
Rectoanal refl ex activity, 104, 108
Rectoceles, 145
Rectosigmoid pressure gradient,
91
Rectovaginal septum. See also
Fistulas, rectovaginal
anatomy of, 145
injury to, 145
Rectum
as anal sphincter support, 125
“buttonhole” tears of, 13, 15, 16,
37–38, 162, 163
hypotonic, 92
hysterectomy-related lacerations
to, 170
sensorimotor function of, 92
Refl ex testing, for faecal
incontinence evaluation,
115–116
Royal College of Obstetricians and
Gynaecologists, perineal
trauma classifi cation
system of, 13, 14
S
Saline continence test, 104, 110,
115
Scintigraphy, radionuclide, 111
SECCA procedure, 155–156, 161,
162, 163
Sexual dysfunction, postpartum,
73–74
Sitz baths, 66
Skin care, anal, 140
Skin tags, perineal, 74
Smoking, as faecal incontinence
risk factor, 135
Somatosensory evoked potentials,
114
Sphincter-modifying drugs, 139
Sphincteroplasty, 154. See also
Anal incontinence, surgical
management of
outcome of, 150–151
Stoma
for faecal incontinence
management, 154, 161
indications for, 148–149
proximal, 115
Stool
loose, 136
anal sphincter injury-related,
145
faecal incontinence-related,
139
scybalous, 103–104
Stool softeners, 41–42, 69
Strength-duration test, 114
Striated muscle atrophy,
130–131
Subepithelium, sonographic
anatomy of, 124, 126
Superfi cial transverse perineal
muscle, 3, 4
Suppositories, as perineal pain
treatment, 66–67
Sweeteners, artifi cial, 136
T
Term Breech Trial, 52, 53–54
Transit studies, 104, 111
U
Ultrasonography
endoanal, 116, 123–132
of anal sphincters, 123–132
of external sphincter repair,
36
following vaginal delivery,
127–130
of normal anal anatomy,
124–127
of obstetric anal sphincter
injuries (OASIS), 17–18, 19,
43, 44, 94, 95, 128–130
of rectovaginal fi stulas, 172
of striated muscle atrophy,
130–131
technique in, 123
as perineal pain treatment, 66
transperineal, 127
vaginal, 127
Urge resistance training, 138
Urinary incontinence
bladder training techniques for,
138
faecal incontinence-associated,
140, 163
postpartum, 73
during pregnancy, 73
pudendal nerve injury-related,
92
Urinary retention, postpartum,
71–73
obstetric anal sphincter injuries
(OASIS) repair-related, 40
Urogenital triangle, 3, 4
Index 195
V
Vacuum extraction delivery, 58–59
Vagina
prolapse of, 135
suturing of, 29
Vaginal delivery
after obstetric anal sphincter
injuries (OASIS), 43–44, 45
as faecal incontinence
cause. See Faecal
incontinence,
postpartum
operative, as perineal trauma
cause, 53, 61
sphincters and perineum after,
127–129
Vaginal examination, guidelines
for, 16
W
Water births, 53, 55
Weight loss, as faecal incontinence
treatment, 141
Wound infections, perineal, 67–68