四象限缝合法在宫颈冷刀锥切术中的应用

Application of four quadrant suture in cervical cold knife conization

目的 探讨宫颈冷刀锥切术中四象限缝合法的临床应用价值。方法 选取2019年1月至2021年12月由沈阳市妇婴医院病理科确诊或经过会诊,诊断为宫颈高级别上皮内瘤变(CINⅡ~Ⅲ级)进行宫颈冷刀锥切术的患者150例,按照不同的缝合方式分为三组:四象限缝合组、改良式Sturmdorf缝合组及环形缝合组,每组50例。比较三组患者的手术时间、术中出血量、术后住院时间、术后感染、术后创面渗血、术后晚期出血情况,并于术后首次月经干净后复诊,了解创面愈合情况(是否出现宫颈管粘连、狭窄、宫颈黏膜增生),术后3、6月门诊随访创面愈合、阴道镜下宫颈成型满意度。结果 三组患者术后住院时间、术后创面渗血、术后是否出现宫颈黏膜增生情况进行比较,差异均无统计学意义(P>0.05),术后复查创面恢复良好,均未出现感染、宫颈管狭窄、粘连形成;四象限缝合组手术时间短于其他两组,术中失血量少于改良式Sturmdorf缝合组,差异具有统计学意义(P<0.05)。术后复查塑形效果良好。结论 宫颈四象限缝合法易于操作、术中止血效果确切,术后宫颈成形美观,值得临床推广应用。

Objective To investigate the clinical application value of four quadrant suture after cervical cold knife conization.Methods From January 2019 to December 2021, 150 patients who were diagnosed as high-level intraepithelial neoplasia of the cervix(CIN Ⅱ-Ⅲ) by pathology or clinical consultation at Shenyang Women’s and Children’s Hospital and received cervical cold knife conization, were selected. According to different suture approaches, the patients were assigned to three groups: four quadrant suture group, modified Sturmdorf suture group and circular suture group, 50 cases in each group. The operation time,intraoperative blood loss, hospital days after operation, postoperative infection, wound bleeding, and late postoperative bleeding were compared among the three groups. After the first post-operational menstruation is clean, the patients were followed up for wound healing(whether there were cervical tube adhesion, stenosis, and cervical mucosal hyperplasia). The outpatient follow-up for wound healing and colposcopy follow-up for molding satisfaction were performed at 3 and 6 months after surgery.Results Hospital days after operation, wound bleeding, and postoperative cervical mucosal hyperplasia were compared and similar among the three groups(P>0.05). The wound healed well after operation, and there were no infection, cervical stenosis and adhesion formation. The operation time of the four quadrant suture group was shorter than that of the other two groups;the intraoperative blood loss was less than that of the modified Sturmdorf suture group, and the differences were statistically significant(P<0.05). Postoperative plastic effect was good. Conclusion Cervical four quadrant suture is easy to operate with precise intraoperative hemostatic effect and beautiful postoperative cervical forming, therefore worthies clinical application.