Brown H W, Rayne S C, Blythe J G, Kraus F T
Department of Obstetrics and Gynecology, St. John's Mercy Medical Center, St. Louis, Missouri 63141, USA.
J Reprod Med. 1995 Sep;40(9):611-3.
The purpose of cold knife conization is to ligate the descending cervical branch of the uterine artery and thus to decrease bleeding. The aim of this study was to investigate the actual frequency of ligation.
Two lateral sutures were placed in the cervix at the 3 and 9 o'clock positions in 97 patients (194 sutures) as part of vaginal hysterectomy. The position of each suture was determined during evaluation of the surgical specimen.
Because the specimens from 10 patients contained only single sutures, only 184 sutures were actually evaluated. Upon microscopic examination, 50 of the 184 (27%) appeared to contain no artery. Of the remaining 134 sutures, 95 (71%) enclosed an artery, and 9 (7%) lay within a 10 x field of a branch. Only 30 sutures (22%) missed the artery entirely. Thus, in the 73% of cases where an artery of significant size could be identified, the artery lay within a lateral stitch 71% of the time.
If the descending cervical branch of the uterine artery supplies most of the blood to the cervix, advance placement of lateral sutures would be expected to reduce blood loss during conization.
冷刀锥切术的目的是结扎子宫动脉的下行宫颈支，从而减少出血。本研究的目的是调查结扎的实际发生率。
作为阴道子宫切除术的一部分，在97例患者（194针缝线）的宫颈3点和9点位置放置两根侧方缝线。在评估手术标本时确定每根缝线的位置。
由于10例患者的标本仅含单根缝线，实际仅评估了184根缝线。显微镜检查显示，184根缝线中有50根（27%）似乎未包含动脉。在其余134根缝线中，95根（71%）包绕了一条动脉，9根（7%）位于分支的10倍视野内。只有30根缝线（22%）完全未结扎到动脉。因此，在73%能识别出较大动脉的病例中，71%的情况下动脉位于侧方缝线内。
如果子宫动脉的下行宫颈支为宫颈供应大部分血液，那么提前放置侧方缝线有望减少锥切术中的失血。
