改良宫颈缝合成形术在冷刀锥切术中应用临床研究

The clinical effect of modified plastic suture of cervix on cold conization

目的探讨改良宫颈缝合术应用于宫颈锥切术治疗宫颈上皮内瘤样病变(CIN)的临床疗效。方法选取自2015年1月至2016年5月在中国医科大学附属盛京医院诊断为CINⅢ行宫颈锥切术的患者89例为研究对象。将患者分为冷刀锥切组(n=48)、电刀锥切组(n=41)。冷刀锥切组使用冷刀宫颈锥切术,并使用改良宫颈缝合成形术止血;电刀锥切组使用电刀锥切术。比较两组患者手术时间、术前术后血红蛋白差值(代表术中出血量)、锥高、延迟出血发生率、宫颈粘连发生率、切缘阳性率。结果冷刀锥切组患者术前术后血红蛋白差值明显低于电刀锥切组,组间比较,差异有统计学意义(P<0.05);椎体高度明显大于电刀锥切组,组间比较,差异有统计学意义(P<0.05);切缘阳性发生率明显低于电刀锥切组,组间比较,差异有统计学意义(P<0.05)。两组患者的手术时间、延迟出血率、宫颈粘连发生率比较,差异均无统计学意义(P>0.05)。结论改良宫颈缝合成形术应用于宫颈锥切术不但具有传统冷刀锥切术的优势,包括无热效应、不影响切缘诊断、足够的椎体高度、切缘阳性率低等,而且具有不延长手术时间、术中出血少、降低延迟出血率等新的优点,值得临床推广应用。

Objective To investigate the clinical efficacy of plastic suture of cervix on cold conization for cervical intraepithelial neoplasia（CIN）. Methods A retrospective study was performed on 89 cases of female patients with CIN Ⅲ who underwent conization of cervix from January 2015 to May 2016. The patients who received cold knife conization and using modified plastic suture of cervix were divided into the cold conization group （n = 48 ）, the others received electrosurgical knife conization were in the electrosurgical knife group （n = 41 ）. Two groups of patients were compared with operation time, the hemoglobin difference before and after surgery （showed the intraoperative blood loss）, vertebral height, delayed bleeding rate, cervical tube adhesion rate and cutting edge positive rate. Re- suits The hemoglobin difference before and after surgery in the cold conization group was significantly lower than that in the electrosurgical knife group（P 〈 0. 05） ;the vertebral height in the cold conization group was significantly higher than that in the electrosurgical knife group （P 〈 0.05 ） ; the cutting edge positive rate in the cold conization group was significantly lower than that in the electrosurgical knife group（P 〈 0. 05 ）. The operation time, delayed bleeding rate and cervical tube adhesion rate had no statistically significant difference （P 〉 0. 05）. Conclusion The modified plastic suture of cervix on cold conization not only has the advantage of traditional cold knife conization,including no thermal effect, the cutting edge diagnosis is not affected, adequate vertebral height, low positive rate of the cutting edge, etc;but also has the advantages such as not prolonged operation time,less intraoperative bleeding,less delayed bleeding rate and other new advantages ,which is worthy of clinical promotion.