PerinealLacerationsandEpisiotomies会阴裂伤和会阴切开术

I.First-degreelacerationI.Ⅰ°裂伤A.Afirstdegreeperineallacerationextendsonlythroughthevaginalandperinealskin.A.Ⅰ°裂伤指仅伤及阴道和会阴部皮肤。B.Repair:Placeasinglelayerofinterrupted3-OchromicorVicrylsuturesabout1cmapart.B.修补：3-0铬制或可吸收缝线1cm距离间断缝合。II.Second-degreelacerationandrepairofmidlineepisiotomyⅡ.Ⅱ°裂伤和会阴正中切开术的修补A.Aseconddegreelacerationextendsdeeplyintothesofttissuesoftheperineum,downto,butnotincluding,theexternalanalsphinctercapsule.Thedisruptioninvolvesthebulbocavernosusandtransverseperinealmuscles.A.Ⅱ°裂伤指深及会阴部软组织，达到但是未延及肛门内扩约肌。包括球海绵体肌和会阴深横肌。B.RepairB.修补1.Proximatethedeeptissuesoftheperinealbodybyplacing3-4interrupted2-Oor3-OchromicorVicrylabsorbablesutures.Reapproximatethesuperficiallayersoftheperinealbodywitharunningsutureextendingtothebottomoftheepisiotomy.1.会阴体深部组织用2-0或3-0铬制或可吸收缝线间断缝合3-4针。会阴体表面连续缝合达到切开会阴的底部。2.Identifytheapexofthevaginallaceration.Suturethevaginalmucosawithrunning,interlocking,3-OchromicorVicrylabsorbablesuture.2.识别会阴裂伤的尖部。阴道粘膜用铬制或可吸收缝线连续锁边缝合。3.Closetheperinealskinwitharunning,subcuticularsuture.Tieoffthesutureandremovetheneedle.会阴皮肤连续皮内缝合。打结，剪下缝针。III.Third-degreelacerationⅢ.Ⅲ°裂伤A.Thislacerationextendsthroughtheperineumandthroughtheanalsphincter.A.穿透会阴和肛门括约肌B.RepairB.修补1.Identifyeachseveredendoftheexternalanalsphinctercapsule,andgraspeachendwithanAllisclamp.1.识别断裂的肛门外括约肌肌束，用艾丽丝钳钳夹。2.Proximatethecapsuleofthesphincterwith4interruptedsuturesof2-Oor3-OVicrylsuture,makingsurethesuturesdonotpenetratetherectalmucosa.2.用2-0或3-0铬制或可吸收缝线缝合肛门括约肌肌束，确保缝线不要穿透直肠粘膜。3.Continuetherepairasforaseconddegreelacerationasabove.Stoolsoftenersandsitzbathsareprescribedpost-partum.3.如上述Ⅱ°裂伤一样继续缝合。产后给予通便药物和坐浴。IV.Fourth-degreelacerationⅣⅣ°裂伤A.Thelacerationextendsthroughtheperineum,analsphincter,andextendsthroughtherectalmucosatoexposethelumenoftherectum.A.裂伤延及会阴、肛门括约肌，穿透直肠粘膜至直肠。B.RepairB.修补1.Irrigatethelacerationwithsterilesalinesolution.Identifytheanatomy,includingtheapexoftherectalmucosallaceration.1.用无菌盐水冲洗伤口。识别解剖结构，包括裂伤的直肠粘膜尖部。2.Approximatetherectalsubmucosawitharunningsutureusinga3-OchromiconaGIneedleextendingtothemarginoftheanalskin.2.使用GI针，用3-0铬制缝线连续缝合直肠粘膜下层，缝至肛门皮肤边缘。3.Placeasecondlayerofrunningsuturetoinvertthefirstsutureline,andtakesometensionfromthefirstlayerclosure.3.在第一层的基础上，连续缝合第二层，降低第一层的张力。4.IdentifyandgraspthetornedgesoftheexternalanalsphinctercapsulewithAllisclamps,andperformarepairasforathird-degreelaceration.Closetheremaininglayersasforaseconddegreelaceration.4.识别撕裂的肛门外括约肌肌束的边缘，并用艾丽丝钳钳夹。然后如缝合Ⅱ°裂伤一样缝合剩下的几层。5.Alow-residuediet,stoolsofteners,andsitzbathsareprescribedpost-partum.5.产后给予少渣饮食，保持大便松软和坐浴