Lee Yong Jae, Park Yunjin, Lee In Ok, Yoon Jung Won, Lee Jung Yoon, Kim Sang Wun, Kim Sunghoon, Kim Young Tae, Nam Eun Ji
Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2017 Jan;60(1):87-91. doi: 10.5468/ogs.2017.60.1.87. Epub 2017 Jan 19.
The aim of this study was to investigate factors preventing delayed hemorrhage after the loop electrosurgical excisional procedure (LEEP).
Medical records of patients who underwent LEEP at one university affiliated hospital from October 2013 to January 2015 were reviewed. Patients with or without delayed hemorrhage were classified. LEEP was performed either in an operating room under general anesthesia or in a procedure room with local anesthesia in the outpatient clinic. Delayed hemorrhage was defined as excisional site bleeding occurring between 1 and 30 days after the LEEP requiring intervention such as electro-cauterization, gauze packing, or application of another hemostatic agent.
During the study period, 369 patients underwent LEEP. Twenty-three (6.2%) patients with delayed hemorrhage returned to our hospital either to the outpatient clinic or to the emergency unit. A third of the population (103, 27.9%) underwent LEEP in the operating room under general anesthesia without injection of local anesthesia. The remaining patients (266, 72.1%) underwent LEEP with local anesthesia (lidocaine HCl 2% with epinephrine 1:100,000) in the office procedure room. Patients given local anesthesia including epinephrine had significantly lower delayed hemorrhage compared to patients with general anesthesia without injection of local anesthesia (=0.001). Hemostats, such as fibrin glue or patch, were used for the majority of patients (346, 93.8%) during the procedure. However, using hemostats was not statistically associated with delayed hemorrhage (=0.163).
Local anesthesia with the powerful vasoconstrictor epinephrine is effective not only to control perioperative bleeding, but also to prevent delayed hemorrhage after LEEP.
本研究旨在探讨预防环形电切术（LEEP）后迟发性出血的因素。
回顾了2013年10月至2015年1月在某大学附属医院接受LEEP治疗的患者的病历。对有或无迟发性出血的患者进行分类。LEEP手术要么在全身麻醉下的手术室进行，要么在门诊的局部麻醉手术室内进行。迟发性出血定义为LEEP术后1至30天内切除部位出血，需要进行电灼、纱布填塞或应用其他止血剂等干预措施。
在研究期间，369例患者接受了LEEP手术。23例（6.2%）迟发性出血患者返回我院门诊或急诊。三分之一的患者（103例，27.9%）在全身麻醉下的手术室接受LEEP手术，未注射局部麻醉剂。其余患者（266例，72.1%）在门诊手术室内接受局部麻醉（含1:100,000肾上腺素的2%盐酸利多卡因）下的LEEP手术。与未注射局部麻醉剂的全身麻醉患者相比，接受含肾上腺素局部麻醉的患者迟发性出血明显更低（=0.001）。手术过程中，大多数患者（346例，93.8%）使用了止血剂，如纤维蛋白胶或贴片。然而，使用止血剂与迟发性出血在统计学上无关联（=0.163）。
含强效血管收缩剂肾上腺素的局部麻醉不仅对控制围手术期出血有效，而且对预防LEEP术后迟发性出血也有效。
