背景:尽管产后肉芽组织(PPGT)的发展是会阴和阴道裂伤愈合的预期阶段,这种组织的持续存在会导致伤口愈合延迟,疼痛,出血,和放电。关于用于病理性PPGT的治疗的功效的信息很少。这项研究的目的是描述与PPGT发展相关的特征以及目前用于管理的治疗方法。
方法:这是一项回顾性队列研究,对2012年至2022年出生后一年内被诊断为PPGT的140例患者进行了研究。根据国际疾病分类和当前程序术语代码鉴定患者。人口统计,出生特征,症状,和治疗信息获得并评估频率和均值。将治疗与95%CI和P值进行比较。通过周数和访问次数来评估解决问题的时间。
结果:这是研究队列中129例(92%)患者的首次阴道分娩。大多数(84.3%)患者出现疼痛。几乎一半的患者(45%)在产后6周后被诊断出。30.0%的患者最初采取保守治疗。76.4%的患者接受硝酸银治疗,33.6%接受了切除手术。成功的保守管理的平均访问次数最低,为1.39次(95%CI,1.15-1.69),其次是硝酸银,就诊次数为1.95次(95%CI,1.73-2.19),和切除伴或不伴硝酸银,随访2.40次(95%CI,2.07-2.78)。保守管理在45%的时间里失败了,需要额外的硝酸银治疗或切除。即使在检查肉芽组织消退后,接受硝酸银或切除术治疗的患者中仍有30%继续报告疼痛。
结论:PPGT通常与首次阴道分娩有关,通常出现在产后6周以上,经常需要治疗。
BACKGROUND: Although the development of postpartum granulation tissue (PPGT) is an expected phase of healing of perineal and vaginal lacerations, the persistence of this tissue can result in delayed wound healing, pain, bleeding, and discharge. There is a paucity of information on the efficacy of the treatments used for pathologic PPGT. The objective of this
study was to describe characteristics associated with the development of PPGT and the treatment methods currently used for management.
METHODS: This was a retrospective cohort
study of 140 patients diagnosed with PPGT within one year of birth from 2012 through 2022 within a single health care system. Patients were identified by International Classification of Diseases and Current Procedural Terminology codes. Demographics, birth characteristics, symptoms, and treatment information were obtained and assessed in frequencies and means. Treatments were compared with 95% CIs and P values. Time to resolution was assessed by the number of weeks and the number of visits.
RESULTS: It was the first vaginal birth for 129 (92%) patients in the
study cohort. The majority (84.3%) of patients presented with pain. Almost half of all patients (45%) were diagnosed after 6 weeks postpartum. 30.0% of patients were initially treated conservatively. 76.4% of patients were treated with silver nitrate, and 33.6% had an excisional procedure. Successful conservative management had the lowest average number of visits to resolution with 1.39 visits (95% CI, 1.15-1.69), followed by silver nitrate alone with 1.95 visits (95% CI, 1.73-2.19), and excision with or without silver nitrate with 2.40 visits (95% CI, 2.07-2.78). Conservative management was unsuccessful 45% of the time, requiring additional treatment with silver nitrate or excision. 30% of patients treated with silver nitrate or excision continued to report pain even after the resolution of granulation tissue upon examination.
CONCLUSIONS: PPGT is commonly associated with first vaginal births, often presents beyond 6 weeks postpartum, and frequently requires treatment.