| Objective:In recent years,with the incidence of Cervical intraepithelial neoplasia(CIN)presenting a younger trend,the patient's fertility should be paid more attention to,cervical minimally invasive surgery such as cervical biopsy and loop electrosurgical excision procedure(LEEP)which help protect cervical function are more widely used in clinical diagnosis and treatment.While,there are postoperative problems such as vaginal bleeding,drainage and slow recovery as well.In clinical practice,to stop bleeding,we used to fill vagina with gauze and cotton.However,the patient has difficulty to take it out,and it may cause continuous bleeding,pain and other discomfort,and some patients even forgot to remove the cotton ball and caused serious reproductive tract infections.This series of clinical problems increases the patient's physical pain and psychological burden,and also increases the difficulty of communication between doctors and patients,which is easy to cause doctor-patient disputes.Therefore,it is necessary to seek a more suitable and effective hemostatic program.Chitosan has been a hot topic in the research of biomass materials since the 21~stt century.It has been widely used in the field of biomaterials due to its characteristics of accelerating wound healing and hemostasis,non-toxicity,antibacterial property,good biocompatibility and biodegradable properties.The biological dressing made of chitosan called chitosan cervical patch is lightweight and easy to apply on the wound surface,which is more convenient for placement;it can be absorbed on the wound surface itself,which can reduce clinical reoperation for removal;more importantly,it can effectively promote hemostasis and repair of the wound surface healing,which is able to shorten the recovery period after trauma.This study was to evaluate the efficacy of using chitosan cervical patch after cervical biopsy and LEEP,so as to explore a new way to promote hemostasis and rapid recovery after minimally invasive cervical surgery,and provide a theoretical basis for the promotion and application of new materials in the clinic and data support.Methods:In the light of inclusion and excluding criteria,400 patients with cervical biopsy and 110 patients with LEEP were selected between January 2019 to January 2020 in the Cervical Disease Center of The First Affiliated Hospital of Chongqing Medical University as research object.With the patient informed and an informed consent signed,400 patients with biopsy(biopsy groups)were numbered by time of visit and divided stochastically into two groups:200 cases in biopsy cervical patch group:apply cervical wound with chitosan cervical patch after biopsy;with 200cases biopsy cotton ball group:cotton ball was applied to the wound surface after biopsy.And 110 patients with LEEP(LEEP groups)were numbered by time of visit and divided stochastically into two groups:55cases in LEEP cervical patch group:applying chitosan cervical patch to the wound after LEEP surgery;with 55 cases in LEEP cotton ball group:cotton ball was applied to the wound surface after LEEP surgery.The perioperative data consist of the duration of bleeding and vaginal drainage,comfort level and adverse reactions were contrasted in the biopsy groups and in the LEEP groups,which were statistically analyzed with SPSS 24.0statistical software to evaluate the efficacy of chitosan.Results:1.A total of 391 cases were collected from the biopsy groups through biopsy follow-up form and later telephone follow-up supplementation,including 197 cases in the biopsy cervical patch group and 194 cases in the biopsy cotton ball group.The average duration of postoperative wound bleeding in the biopsy chitosan group was 2.55±1.26d,which was shorter than 3.16±1.35 d in the biopsy cotton ball group(P<0.01).The average postoperative vaginal drainage time of the biopsy cervical patch group was 3.21±1.35 d,which was shorter than 3.61±1.45d of the biopsy cotton ball group(P<0.01).The incidence of the pain arisen by taking cotton ball in the biopsy cotton ball group was 21.1%,while there was such discomfort in the biopsy chitosan group(P<0.01).Both the biopsy cervical patch group and the biopsy cotton ball group had no postoperative heavy bleeding or infection.In addition,10 cases of adverse reactions(odor and pruritus)of vaginal secretions were monitored after the application of chitosan cervical patch,including 7 cases of vaginal discharge odor symptoms,2 cases of external genital itching,and 1 case combined with discharge odor and external genital itching symptoms.2.A total of 104 cases were collected from the LEEP groups through LEEP follow-up form and later telephone follow-up supplementation,including 51 cases in the LEEP cervical patch group and 53 cases in the LEEP cotton ball group.In the LEEP cervical patch group,11 patients had postoperative wound bleeding time of less than 1 week,36 patients in 1 to2 weeks,and 4 patients in more than 2 weeks;and 7 patients in LEEP cotton ball group had less than 1 week of wound bleeding time,41 cases were in 1 to 2 weeks and 5 cases were more than 2 weeks.In the LEEP cervical patch group,there were 9 patients with vaginal discharge less than 1 week after operation,37 patients with 1 to 2 weeks,and 5 patients with 2 weeks and above;9 patients in LEEP cotton ball group with less than 1 week,36 cases in 1 to 2 weeks,8 cases in more than 2 weeks,the difference in not only postoperative wound bleeding time but vaginal drainage time between the LEEP cervical patch group and the LEEP cotton ball group was not statistically significant(P>0.05).The incidence of the pain arisen by taking cotton ball in the LEEP cotton ball group was 26.4%,while there was such discomfort in the LEEP cervical patch group(P<0.01).And no significant difference had been found in the incidence of postoperative infection as well as heavy bleeding between the LEEP cervical patch group and the cotton ball group(P>0.05).In addition,4cases of adverse reactions(odor and pruritus)of vaginal secretions were monitored after the application of chitosan cervical patch,including 2 cases of vaginal discharge odor symptoms,1 case of external genital itching,and1 case combined with discharge odor and external genital itching symptoms.Conclusion:1.Chitosan cervical patch on the wound surface after cervical biopsy is safe and effective,can which can promote wound hemostasis,shorten the bleeding and vaginal drainage time,and is more comfortable than the traditional hemostasis with cotton ball,which is worth clinical promotion.2.The comfort of using chitosan cervical patch after cervical LEEP is better than that of traditional cotton ball compression,However,sufficient evidence has not been obtained to prove that its curative effect is better than that of cotton ball compression.The reason and mechanism involved in this phenomenon still need to be further explored to seek better clinical curative effect.3.In the application of chitosan cervical patch,patients occasionally see odor of leucorrhea and itching symptoms of External genitalia.The specific reasons are for further study.In clinical applications,informed consent and follow-up adverse reactions need to be obtained. |
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