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发布者:鑫达医学翻译 发布时间:2013-02-19 8:50:52 阅读:

原文:
Decreased Incidence of Vaginal Cuff Dehiscence after Laparoscopic Closure with Bidirectional Barbed Suture

Study Objective: To estimate whether a new surgical technique is associated with lower incidence of postoperative breakdown of the vaginal cuff after laparoscopic hysterectomy or trachelectomy, compared with previous methods of closure.
Design: Retrospective cohort study, Canadian Task Force Classification II-3.
Setting: Tertiary-care university-based teaching hospital.
Patients: Patients who underwent laparoscopic vaginal closure after removal of the uterus and/or cervix by members of a subspecialty gynecologic laparoscopy division from January 2007 to January 2010 (n 5 387).
Interventions: Use of bidirectional barbed suture for laparoscopic vaginal cuff closure.
Measurements and Main Results: A total of 387 patient records were reviewed. The incidence of vaginal cuff dehiscence among those with other methods of closure was 4.2%, while there were no cases of dehiscence among those who had closure with bidirectional barbed suture (p5.008). Postoperative bleeding (OR 2.3, 95% C.I. 1.3–3.9), presence of granulation tissue (OR 1.9, 95% C.I. 0.92–3.9), and cellulitis (OR 4.6, 95% C.I. 1.0–21.1) all occurred more frequently in patients without barbed suture closure.
Conclusion: Dehiscence of the vaginal cuff after laparoscopic closure is a rare but important complication in gynecologic surgery. Use of bidirectional barbed suture eliminated the problem in our first year of experience with the technique. We also observed a decreased incidence of other common problems of the vaginal cuff. This method is easy to learn and inexpensive and does not require advanced skills such as laparoscopic knot-tying.

译文:
腹腔镜下使用双向锯齿缝线降低阴道袖口撕裂发生率
目的:评价腹腔镜子宫切除术或子宫颈切除术后,双向锯齿缝线能否降低阴道袖口撕裂发生率。
试验设计:回顾性队列研究。
患者:2007年1月至2010年1月接受子宫或子宫颈去除术后实施腹腔镜阴道闭合术的患者。患者总数为387例。
干预:采用双向锯齿缝线实施阴道袖口闭合术。
方法与结果:本研究共纳入387例患者。锯齿缝线组患者未发现阴道袖口撕裂发生;而传统手术组阴道撕裂发生率为4.2%(P=0.008)。传统缝线组常出现术后失血(OR 2.3, 95% C.I. 1.3–3.9)、肉芽组织形成(OR 1.9, 95% C.I. 0.92–3.9)、蜂窝织炎(OR 4.6, 95% C.I. 1.0–21.1)。
结论:腹腔镜检下阴道袖口撕裂虽不常见,但为一种重要的妇科并发症。我们的研究发现,使用锯齿缝线可避免阴道袖口撕裂,且其他并发症发生率降低。该方法操作简单、费用不高,且无需在腹腔镜下实施打结。

 


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