Johnson N, Crompton A C
Colposcopy Clinic, St. James's University Hospital, Leeds, Yorkshire, United Kingdom.
Gynecol Oncol. 1994 Jan;52(1):44-9. doi: 10.1006/gyno.1994.1009.
To identify women who find outpatient laser cervical surgery painful we designed a prospective observational study correlating surgical pain with multiple variables. The pain scoring systems were validated by comparing the subjective linear analogue score with an objective scoring method. The pain of surgery was compared with age, parity, acute anxiety scores, psychological state, premenstrual syndrome scores, phase of the menstrual cycle, contraceptive use, menstrual history, nature of the lesion, and intraoperative bleeding. Anxious women with no children suffered most. Nulliparity, acute preoperative anxiety, and a history of dysmenorrhea independently predict high pain scores. Young women and those using the combined oral contraceptive pill also find laser surgery more painful but this is because they are less likely to have delivered children and more likely to suffer from dysmenorrhea. Psychological state, premenstrual syndrome score, phase of the menstrual cycle, type of surgery, and perioperative bleeding have no predictive value. We suggest that nulliparous women and dysmenorrhea sufferers who are anxious about outpatient surgery but ambivalent about hospital admission should be offered cervical surgery under general anesthesia. Parous women who do not suffer from dysmenorrhea can be reassured that outpatient laser treatment should be tolerable.
为了找出那些觉得门诊激光宫颈手术很疼的女性，我们设计了一项前瞻性观察性研究，将手术疼痛与多个变量相关联。通过将主观线性模拟评分与客观评分方法进行比较，对疼痛评分系统进行了验证。将手术疼痛与年龄、产次、急性焦虑评分、心理状态、经前综合征评分、月经周期阶段、避孕方式、月经史、病变性质和术中出血情况进行了比较。没有孩子的焦虑女性疼痛最为明显。未生育、术前急性焦虑和痛经史可独立预测高疼痛评分。年轻女性和服用复方口服避孕药的女性也觉得激光手术更疼，但这是因为她们生育孩子的可能性较小，患痛经的可能性较大。心理状态、经前综合征评分、月经周期阶段、手术类型和围手术期出血情况没有预测价值。我们建议，对于那些对门诊手术感到焦虑但对住院又犹豫不决的未生育女性和痛经患者，应在全身麻醉下进行宫颈手术。对于没有痛经的经产妇，可以让她们放心，门诊激光治疗应该是可以耐受的。
