Afolabi Muhibat A., Ezeoke Grace G., Saidu Rakiya, Ijaiya Munirdeen A., Adeniran Abiodun S.
Department of Obstetrics and Gynecology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
Department of Obstetrics and Gynecology, University of Ilorin, Ilorin, Nigeria
J Turk Ger Gynecol Assoc. 2019 Feb 26;20(1):23-30. doi: 10.4274/jtgga.galenos.2018.2018.0049. Epub 2018 Nov 30.
To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy.
A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility in Nigeria. Participants were recruited after they gave informed consent and randomized into group I (single dose 400 μg vaginal misoprostol one-hour before surgery) and group II (intraoperative pericervical hemostatic tourniquet). Eighty participants (40 in each group) were recruited. Uterine size was measured in centimeters above the pubic symphysis, and blood loss estimation involved direct volume measurement and gravimetric methods. The main outcome measures were intraoperative blood loss, blood transfusion, and recourse to hysterectomy. Ethical approval and trial registration were obtained; the data were analyzed using the SPSS software version 21.0; p<0.05 was considered significant.
Participants in group I had higher mean intraoperative blood loss (931.89±602.13 vs 848.40±588.85 mL, p=0.532), intra-operative blood transfusion rates (60 vs 55%; p=0.651) and mean units of blood transfused (1.30±1.20 vs 1.20±1.30; p=0.722) compared with group II. The mean uterine size (19.50±6.93 vs 20.05±6.98 cm; p=0.725) and number of fibroid nodules (11.25±7.99 vs 11.45±8.22; p=0.912) were comparable. The change in post-operative hematocrit was 2.66±2.21% vs 3.24±2.85% (p=0.315) and post-operation blood transfusion was 2.5 vs 5% (p=0.556). There was no recourse to hysterectomy in either of the study groups. While adverse effects of misoprostol occurred in 5 (12.5%) participants of group I.
The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative hemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy.
比较围手术期阴道使用米索前列醇与术中宫颈周围止血带在减少子宫肌瘤剔除术出血量方面的效果。
在尼日利亚一家三级医疗机构对接受子宫肌瘤剔除术的子宫平滑肌瘤女性患者进行了一项随机对照试验。参与者在签署知情同意书后被招募，并随机分为第一组（术前1小时单剂量400μg阴道米索前列醇）和第二组（术中宫颈周围止血带）。共招募了80名参与者（每组40名）。通过测量耻骨联合上方厘米数来测量子宫大小，采用直接容量测量法和重量法估计失血量。主要观察指标为术中失血量、输血情况及子宫切除术的实施情况。获得了伦理批准并进行了试验注册；使用SPSS 21.0软件对数据进行分析；p<0.05被认为具有统计学意义。
与第二组相比，第一组参与者的术中平均失血量更高（931.89±602.13 vs 848.40±588.85 mL，p = 0.532），术中输血率更高（60% vs 55%；p = 0.651），平均输血量更高（1.30±1.20 vs 1.20±1.30；p = 0.722）。平均子宫大小（19.50±6.93 vs 20.05±6.98 cm；p = 0.725）和肌瘤结节数量（11.25±7.99 vs 11.45±8.22；p = 0.912）相当。术后血细胞比容的变化分别为2.66±2.21%和3.24±2.85%（p = 0.315），术后输血情况分别为2.5%和5%（p = 0.556）。两个研究组均未实施子宫切除术。第一组有5名（12.5%）参与者出现了米索前列醇的不良反应。
在减少子宫肌瘤剔除术出血量方面，围手术期阴道使用米索前列醇的效果与术中宫颈周围止血带相当。
