剖宫产子宫肌层不同缝合方式对妊娠结局影响的Meta分析

目的:采用Meta分析探讨剖宫产子宫肌层单层缝合与双层缝合对妊娠结局的影响,为临床手术提供一定理论依据。方法:按严格的纳入和排除标准,检索万方、CNKI、Pub Med、Cochrane Library、Embase、Cisma等数据库,对纳入的相关随机对照研究进行质量评价,采用Rev Man 5.3软件进行数据分析。结果:纳入文献18篇,共15370例。与双层缝合比较,单层缝合的平均失血量少(MD=-62.78,95%CI为-113.24~12.32,P=0.01),住院天数短(MD=-0.56,95%CI为-0.84~-0.27,P=0.0001),但术后6月子宫残余肌层薄(MD=-1.52,95%CI为-2.89~-0.16,P=0.03)、愈合率低(MD=-1.52,95%CI为-2.89~-0.16,P=0.03)。结论:剖宫产子宫肌层单层缝合与双层缝合术比较,单层缝合的失血量少、住院天数短,但在术后6月残余肌层厚度及子宫肌层愈合率方面,双层缝合更有优势。

A meta-analysis of outcomes of different surgical closure for cesarean

Objective:A meta-analysis were performed to estimate the clinical outcomes of single vs double layers in cesarean delivery techniques. Method:Formulating strict inclusion criteria and exclusion criteria,different surgical closure for cesarean were searched in Wanfang, CNKI,PubMed, Cochrane Library, Embase, Cisma. Only randomized controlled trials ( RCT ) were included. After evaluating the quality of the literature,we use RevMan 5. 3 for meta-analy-sis. Results:18(15370 patients) were included in the analysis. Compared to double-layer clo-sure,single-layer closure had less blood loss (MD=-62. 78,95%CI=-113. 24~-12. 32,P=0. 01),shorter hospitalization days (MD=-0. 56,95%CI=-0. 84~-0. 27,P=0. 0001). Sin-gle-layer closure was also associated with thinner residual myometrial thickness( RMT) ( MD=-1. 52,95%CI=-2. 89~-0. 16,P=0. 03) and lower healing ratio than double layers. Con-clusion:Single-layer closure may reduce the amount of blood loss and shorten the hospitaliza-tion. However,double-layer closure is associated with higher residual myometrial thickness and greater healing ratio in 6 months after cesarean.