改良荷包缝合法在宫颈冷刀锥切术中的应用价值

Application value of modified purse-string suture in cold knife conization

目的探讨改良荷包缝合法在宫颈冷刀锥切术（CKC）中的应用价值。方法选择2009年1月至2013年12月于长江大学附属第一医院妇科行CKC的291例宫颈上皮内瘤变（CIN）Ⅱ~Ⅲ患者为研究对象。按照不同的缝合方式,将接受传统Sturmdorf缝合法缝合的130例患者纳入对照组,将接受改良荷包缝合法缝合的161例患者纳入改良组。对比分析两组患者的手术时间、住院时间、术中出血量、术后晚期出血量、术后活组织检查结果、术后宫颈塑性满意度、术后发热情况和术后3个月随访情况。两组患者的年龄、孕次、产次、绝经与否、CINⅡ和CINⅢ的构成比等一般临床资料比较,差异无统计学意义（P〉0.05）。本研究遵循的程序符合长江大学附属第一医院人体试验委员会制定的伦理学标准,得到该委员会批准。结果1改良组患者的平均手术时间为（28.2±7.9）min,对照组为（40.5±9.4）min,两组比较,差异有统计学意义（t=12.127,P〈0.05）。改良组患者术后平均住院时间为（3.7±1.3）d,对照组为（4.2±1.2）d,并且差异无统计学意义（t=3.375,P〉0.05）。2改良组患者平均术中出血量为（38.6±24.3）mL;对照组为（67.0±18.6）mL,并且差异有统计学意义（t=10.978,P〈0.05）。改良组患者的平均术后晚期出血量为（13.5±6.2）mL,对照组为（16.3±5.7）mL,并且差异无统计学意义（t=3.970,P〉0.05）。3术后活组织检查结果（病理升级、浸润癌检出率及切缘阳性率）比较,差异无统计学意义（P〉0.05）。4两组患者宫颈塑形满意度比较,差异有统计学意义（χ2=14.883、8.432、7.587,P〈0.05）。5两组患者术后发热情况比较,差异无统计学意义（χ2=0.103,P〉0.05）。6术后3个月随访结果显示,改良组患者术后宫颈管肉芽形成率及宫颈黏连发生率显著低于对照组,并且差异有统计学意义（χ2=4.638、3.754,P〈0.05）;但两组患者术后细胞学检出异常率比较,差异无统计学意义（χ2=0.445,P〉0.05）。结论改良荷包缝合法操作简单,手术时间短,止血及宫颈成形效果好,是CKC诊疗中值得推广的缝合方法。

Objective To discuss the clinical application value of modified purse-string suture in cervical wound after cold knife conization（CKC）.Methods Medical records of 291 patients who received CKC treatment of cervical intraepithelial neoplasia（CIN）Ⅱ-Ⅲin Department of Gynecology and obstetrics,First People′s Hospital of Yangtze University from January 2009 to December 2013 were included into this study.They were divided into modified group（n=161）and control group（n=130）according to two different suture methods.A total of 161 cases with modified purse-string suture from January 2012 to December 2013 were included into modified group,and another 130 cases with traditional Sturmdorf suture from January 2009 to December 2011 were included into control group.Operation time, hospitalization, intraoperative and postoperative blood loss, postoperative histopathological examination results,postoperative cervical plastic satisfaction,postoperative fever and postoperative follow-up of 3 months between two groups were compared.There were no statistically significant differences bwteen two groups in the aspects of age,gravidity,parity and the proportion of menopause（P〈0.05）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First People′s Hospital of Yangtze University.Results 1The operation time of modified group and control group were（28.2±7.9）min and（40.5±9.4）min,respectively,which had statistically significant difference（t=12.127,P〈0.05）.The hospitilization of modified group and control group were（3.7±1.3）d and（4.2± 1.2）d,and there was no statistically significant difference（t=3.375,P〈0.05）.2 The average intraoperative blood loss of modified group was（38.6±24.3）mL and control group was（67.0±18.6）mL,and the difference was statistically significant（t=10.978,P〈0.05）.The postoperative blood loss of modified group was（13.5± 6.2）mL and control group was（16.3±5.7）mL,and there was no statistically significant difference（t=3.970,P〈0.05）.3There were no significant differences between two groups in the histopathological examination results（the incidence rates of pathological upgrade,invasive cervical cancer detection and positive surgical margin）（P〈0.05）.4 There were significant differences between two groups in postoperative cervical shape satisfaction（χ2=14.883,8.432,7.587;P〈0.05）.5There were no significant difference between two groups in fever（χ2=0.103,P〈0.05）.6 After 3 months follow-up,the incidence rates of cervical granulation and cervical adhesion of modified group were significant lower than those of control group,which had significant differences（χ2=4.638,3.754;P〈0.05）.Meanwhile,there was no statistically significant difference between two groups in abnormity rate of cytology（χ2=0.445,P〈0.05）.Conclusions The modified purse-string suture presents effective hemostasis in CKC,leading to simple operation,short operation time,less blood loss and shorter postoperative hospitalization.