Kamat Aparna A, Kramer Paul, Soisson Andrew P
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
Obstet Gynecol. 2003 Oct;102(4):726-30. doi: 10.1016/s0029-7844(03)00622-7.
To compare the efficacy of electrocautery with that of the suture method for achieving hemostasis of the cervical cone bed.
We performed a retrospective chart review of all patients who underwent cold-knife conization of the cervix over a 5-year period. Patients were categorized into two groups: the cautery group, in which the cone bed was electrocauterized with a hand-held electrocoagulation device; and the suture group, in which hemostasis was achieved by a continuous locking suture placed circumferentially around the cone bed. Outcome measures evaluated include estimated blood loss, operative time, and incidence of complications, including secondary hemorrhage, cervicitis, and cervical stenosis. Data were analyzed by Student t test, chi(2) test, linear regression, and multiple logistic regression where appropriate.
There were 156 women in the cautery group and 35 in the suture group. The cautery group had significantly lower estimated blood loss (27 mL versus 101 mL; P <.01) and shorter operative time (34 versus 43 minutes; P <.01) than the suture group. The procedure-related complication rate was 6.4% in the cautery group, compared with 14.3% in the suture group (P = nonsignificant). A higher use of lateral sutures, vasopressors, and thrombotic agents was seen in the cautery group. However, even after adjusting for these variables, mean estimated blood loss (33 mL, P <.01) and mean operative time (34 minutes, P <.01) were significantly less in the cautery group than in the suture group.
Cauterization of the cone bed is superior to suture as a method of achieving hemostasis, with significantly less blood loss and shorter operative time.
比较电灼法与缝合法实现宫颈锥切创面止血的疗效。
我们对5年内接受宫颈冷刀锥切术的所有患者进行了回顾性病历审查。患者分为两组：电灼组，使用手持电凝装置对锥切创面进行电灼；缝合组，通过在锥切创面周围环形连续锁边缝合来实现止血。评估的结果指标包括估计失血量、手术时间以及并发症发生率，并发症包括继发性出血、宫颈炎和宫颈狭窄。数据在适当情况下通过学生t检验、卡方检验、线性回归和多元逻辑回归进行分析。
电灼组有156名女性，缝合组有35名女性。电灼组的估计失血量（27毫升对101毫升；P<.01）和手术时间（34分钟对43分钟；P<.01）显著低于缝合组。电灼组的手术相关并发症发生率为6.4%，而缝合组为14.3%（P无统计学意义）。电灼组使用侧方缝合、血管加压药和血栓形成剂的频率更高。然而，即使对这些变量进行调整后，电灼组的平均估计失血量（33毫升，P<.01）和平均手术时间（34分钟，P<.01）仍显著低于缝合组。
作为一种实现止血的方法，锥切创面电灼优于缝合，失血量显著减少且手术时间更短。
