Martin-Hirsch Pierre Pl, Keep Sarah L, Bryant Andrew
Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, UK, PR2 9HT.
Cochrane Database Syst Rev. 2010 Jun 16(6):CD001421. doi: 10.1002/14651858.CD001421.pub2.
Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss.
To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN.
We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to April 2009. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.
Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN.
Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses.
Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09).
AUTHORS' CONCLUSIONS: Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.
宫颈上皮内瘤变（CIN）是最常见的癌前病变。CIN的手术治疗通常伴有失血。
评估预防CIN治疗期间失血的干预措施的有效性和安全性。
我们检索了截至2009年4月的Cochrane妇科癌症组试验注册库、MEDLINE、EMBASE和CENTRAL。我们还检索了临床试验注册库、科学会议摘要以及纳入研究的参考文献列表。
关于接受CIN手术的女性使用血管加压素、氨甲环酸、止血缝线、氨基宫颈凝胶或孟塞尔溶液的随机对照试验（RCT）。
两名评价员独立提取数据并评估偏倚风险。将接受其中一种干预措施的女性不良事件的风险比汇总到随机效应荟萃分析中，或纳入单项试验分析。
纳入了12项RCT（N = 1602，其中1512例接受评估）。与安慰剂相比，血管加压素显著减少围手术期出血（平均差（MD）=-100.80，95%置信区间（CI）-129.48至-72.12），并降低了需要止血缝线或进一步使用血管加压素的出血风险（风险比（RR）=0.39，95%CI 0.27至0.56）。与安慰剂相比，氨甲环酸显著降低了刀锥切和激光锥切活检后继发性出血的风险（RR = 0.23，95%CI 0.11至0.50），但对原发性出血无显著影响（RR = 1.24，95%CI 0.04至38.23）。与安慰剂相比，术后失血也有统计学显著减少（MD = -55.60，95%CI -94.91至-16.29）。与常规缝合相比，用孟塞尔溶液填塞导致围手术期失血更少（MD = -22.00，95%CI -23.09至-20.91），并降低了痛经风险（RR = 0.37，95%CI 0.16至0.84）、不满意阴道镜检查风险（RR = 0.43，95%CI 0.
