Stovall T G, Summitt R L, Lipscomb G H, Ling F W
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Obstet Gynecol. 1991 Sep;78(3 Pt 1):415-8.
To compare two methods of vaginal cuff closure during abdominal hysterectomy, 60 patients were randomized to one of two cuff-closure methods. The vaginal cuff was closed with three interrupted 0-Dexon sutures in 30 and with absorbable staples in 30. Both groups were similar with respect to age, gravidity, parity, preoperative indication, hemoglobin, and hematocrit. The operative technique and quantity of irrigation used was standardized. Operative blood loss was calculated by the weight method and an unactivated, medium flat Jackson-Pratt drain was left in place for collecting postoperative cuff cultures at 24 and 48 hours. The mean operative times in the suture group (97.4 minutes) and staple group (93.4 minutes) were not significantly different (P greater than .05). Cuff-closure time was more rapid (P = .0001) in the staple group (5.8 minutes) than in the suture group (9.3 minutes). Intraoperative cultures were positive in eight of 30 suture patients (26.7%) and eight of 30 staple patients (26.7%). Postoperative cultures at either 24 or 48 hours were positive in four women (13.3%) in the suture group and six (20%) in the staple group. Febrile morbidity occurred in six (20%) in each group. Three staple and two suture subjects developed a vaginal cuff abscess or hematoma, one of whom was readmitted to the hospital for intravenous antibiotics and draining of the vaginal cuff abscess. The presence of a positive vaginal cuff culture did not predict clinical outcome. Based on these observations and the increased cost of the stapling device, we conclude that there is no significant clinical advantage of surgical staples over traditional sutures for vaginal cuff closure at abdominal hysterectomy.
为比较腹式子宫切除术中两种阴道残端闭合方法，将60例患者随机分为两种残端闭合方法中的一组。30例患者用3根间断的0号 Dexon缝线闭合阴道残端，30例用可吸收吻合钉闭合。两组在年龄、孕次、产次、术前指征、血红蛋白和血细胞比容方面相似。手术技术和冲洗量标准化。采用称重法计算术中失血量，并留置未激活的中型扁平Jackson-Pratt引流管，用于在术后24小时和48小时采集阴道残端培养物。缝线组的平均手术时间（97.4分钟）和吻合钉组（93.4分钟）无显著差异（P大于0.05）。吻合钉组的残端闭合时间（5.8分钟）比缝线组（9.3分钟）更快（P = 0.0001）。30例缝线患者中有8例（26.7%）术中培养阳性，30例吻合钉患者中有8例（26.7%）。缝线组4名女性（13.3%）在术后24小时或48小时的培养阳性，吻合钉组6名（20%）。每组均有6例（20%）发生发热性疾病。3例吻合钉组和2例缝线组患者发生阴道残端脓肿或血肿，其中1例因静脉使用抗生素和引流阴道残端脓肿再次入院。阴道残端培养阳性并不能预测临床结局。基于这些观察结果以及吻合钉装置成本的增加，我们得出结论，在腹式子宫切除术中，手术吻合钉在阴道残端闭合方面相对于传统缝线没有显著的临床优势。
