单、双极电凝在宫颈锥形切除术中的应用价值

Application of Mono-polar Combined with Bipolar Coagulation in Clinical Treatment of Cervical Conization

目的探讨单、双极电凝在宫颈锥形切除术中的临床应用价值。方法回顾性分析2009年6月至2013年10月期间在中国医科大学附属盛京医院接受改良法普通单、双极电凝行宫颈锥形切除术的105例患者(电刀组)的临床资料,随机选取同期92例冷刀宫颈锥切患者(冷刀组)进行比较。结果电刀组手术时间短于冷刀组[(14.3±7.4)min和(45.0±11.2)min,P<0.01],术中出血量少于冷刀组[(6.0±4.2)mL和(62.0±16.2)mL,P<0.01],锥高及手术前后的病理符合率与冷刀组无统计学差异[(23.2±3.1)mm和(21.2±4.1)mm,P>0.05;66.7%和66.3%,P>0.05]。电刀组无术后发热、出血及宫颈粘连病例(冷刀组不详),切缘热损伤范围较小,不影响病理诊断,术后宫颈成型效果好,术后12个月治愈率为92.4%。结论经过操作技巧改良后,普通电刀宫颈锥形切除不影响病理结果,应用单、双极电凝行宫颈锥形切除术具有手术时间短、术中出血少、切除深度足够及术后并发症少等优点,能获得很好的宫颈成型效果及治疗效果。

Objective To evaluate the clinical value of mono-polar combined with bipolar coagulation forceps in conization. Methods A retrospective study was carried out. A total of 105 cases who undertook general electrosurgical knife combined with bipolar coagulation forceps conization（EKC group）at Shengjing Hospital of China Medical University between June 2009 and October 2013 were studied. Totally 92 cases of cold knife conization（CKC group）performed during the same study interval were enrolled as control group. Results The operative time in EKC group was（14.3±7.4 min）,which was shorter than that in CKC group（45.0±11.2 min）（P〈0.01）;the amount of blood loss during operation in EKC group was（6.0±4.2）mL,which was lower than that in CKC group（62.0±16.2 mL）（P〈0.01）. There was no significant difference in the thickness of conization（23.2±3.1 and 21.2±4.1 mm,P〉0.05）and in the coincidence rate of histopathological diagnose of cone specimens and multiple biopsies（66.7% and 66.3%,P〉0.05）. No patient of EKC group suffered from postoperative fever,cone-bed bleeding or cervical adhesion;however,the condition of CKC group were unknown. The cutting edge of all cases of EKC group occurred relatively mild thermal damage that didn＇t affect the histopathological results. All patients of EKC group obtained good tracheloplastic effects. The following up curative rate was 92.4% at the time points of twelve months after conization. Conclusion With some modification of the procedures,electrosurgical knife conization does not affect the postoperative pathological results. Mono-polar combined with bipolar coagulation forceps conization with enough excisional depth could be finished within a short operative time,without much blood loss and with less complications. The procedure also can obtain good cervical tracheloplastic effects and good therapeutic effects.