首次剖宫产单层缝合法与双层缝合法有效性与安全性的Meta分析

摘要

Objective:To assess the efficacy and safety of different sutures (Single-layer Closure and Double-layer Closure) for the first cesarean section.Methods:The databases such as CENTRAL,PubMed,SCIE,Embase,CNKl,VlP and WANFANG between 2005 to 2016 were searched to collectthe randomized control trials (RCTs) about the efficacy and safety of the first cesarean section single-layer closure and double-layer closure,the meta-analysis was performed by using the Revman 5.2 software.Results:A total of 15 references involving 10929 patients were included,of which 6778 cases of cesarean section used a single-layer closure,4151 cases used a double-layer closure.The Meta-analysis showed that compared with single-layer closure,the double-layer closure had longer operation time(Z=2.46,MD-4.01,95％CI-7.22 ～-0.81,P=0.01),more intraoperative blood loss(Z =85.49,M D 69.97,95％ CI 68.36 ～ 71.57,P ＜ 0.00001),higher incidence of irregular menstruation (Z =3.52,OR 2.41,,95 ％ C I 1.48 ～ 3.93,P =0.0004),lower incidence of scar diverticulum (Z =2.20,OR 1.5,95％ CI 1.05 ～ 2.15,P =0.03),higher incidence of poor healing of uterine incision (Z =3.03,OR 2.62,95％ CI 1.40 ～4.88,P =0.002).There was no significant difference of incidence of postpartum hemorrhage(Z =1.27,OR 1.54,95％CI 0.79 ～2.98,P =0.20) and secondary pregnancy with threatened uterine rupture or uterine rupture(Z=1.63,OR 2.02,95％ CI 0.87 ～ 4.72,P =0.10)between the two sutures.Conclusions:For the different closure of cesarean section,double-layer closure can increase the operation time and intraoperative blood loss,but can decrease the rate of irregular menstruation,poor healing of the uterine incision and scar diverticulum.Since the meta-analysis included in the literature is retrospective study,and the quality of the literature is not high,which may have some influence on the authenticity of the conclusion.It is suggested that the clinical gynecologist should make their choice carefully.%目的:评估首次剖宫产单层缝合法与双层缝合法的有效性与安全性.方法:检索CEN-TRAL、PubMed、SCIE、Embase、CNKI、VIP、万方等数据库,检索时限为2005 ～ 2016年,收集首次剖宫产单层缝合法与双层缝合法有效性与安全性的相关文献.采用Revman5.2软件进行Meta分析.结果:纳入文献15篇,共有10929例剖宫产手术,其中6778例剖宫产采用的是单层缝合法,4151例采用的是双层缝合法.Meta分析结果显示:与首次剖宫产单层缝合法相比较,双层缝合法手术时间较长(Z =2.46,MD-4.01,95％CI-7.22 ～-0.81,P=0.01),术中出血量多(Z =85.49,MD 69.97,95％CI 68.36 ～71.57,P＜0.00001),术后月经不调发生率低(Z=3.52,OR 2.41,95％ CI 1.48～3.93,P=0.0004),瘢痕憩室发生率低(Z =2.20,OR 1.5,95％ CI 1.05～2.15,P=0.03),子宫切口愈合不良发生率较低(Z =3.03,OR2.62,95％ CI 1.40～4.88,P=0.002),产后出血发生率(Z=1.27,OR 1.54,95％CI 0.79 ～2.98,P=0.20)及再次妊娠先兆子宫破裂或子宫破裂(Z=1.63,OR2.02,95％ CI 0.87 ～4.72,P=0.1O)差异无统计学意义.结论:对于剖宫产不同缝合方式而言,双层缝合法增加了手术时间及术中出血量,但可降低术后月经不调、切口愈合不良及瘢痕憩室发生率,由于本Meta分析纳入文献基本为回顾性研究,且文献质量不高,可能对结论的真实性有一定影响,建议临床妇产科医师谨慎选择.