宫腹腔镜联合手术与经阴式手术比较治疗剖宫产切口憩室的Meta分析  

The hysteroscopy combined with laparoscopy versus the vaginal operation in treating patients with PCSD: a Meta-analysis

作　　者：陈雨柔[1] 张蔚[1] 刘福林[1] 吴寒舒 易跃雄[1] 吴婉蓉[1] 

机构地区：[1]武汉大学人民医院妇科,武汉430060

出　　处：《现代妇产科进展》2016年第9期667-672,共6页Progress in Obstetrics and Gynecology

摘　　要：目的:评价宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的效果。方法:检索the Cochrane Central Register of Controlled Trials(CENTRAL)、Pub Med、SCIE、EMbase、CNKI、VIP、万方数据库等数据库,查找宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的随机对照试验(RCT)相关文献,同时手检纳入文献的参考文献。按纳入排除标准由2名评价员独立进行RCT的筛选、资料提取和质量评估后,采用Rev Man5.1软件进行Meta分析。结果:纳入文献14篇,共884例患者,其中481例行宫腹腔镜联合手术或宫腔镜电切手术或开腹手术(观察组),403例仅行经阴式手术(对照组)。Meta分析显示,与经阴式手术比较,宫腹腔镜联合手术患者的手术时间较长(MD=13.99,95%CI为4.76~23.23,P=0.003),术中出血少(MD=-13.08,95%CI为-22.98^-3.18,P=0.01),住院时间短(MD=-2.10,95%CI为-3.45^-0.75,P=0.002),治疗费用多(SMD=6.93,95%CI为4.50~9.35,P<0.00001),术后总并发症发生率低(RR=0.38,95%CI为0.19~0.75,P=0.006),术后阴道出血时间短(MD=-3.16,95%CI为-5.26^-1.05,P=0.003),术后肛门排气时间差异无统计学意义(MD=0.26,95%CI为-0.22~0.75,P=0.29),术后月经恢复情况好(OR=1.89,95%CI为1.11~3.20,P=0.02),术后憩室修复情况好(OR=2.16,95%CI为1.20~3.88,P=0.010)。结论:宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室比较,手术时间较长,治疗费用高,术后肛门排气时间无明显差异,但住院时间短,术后阴道出血时间短,术中出血少,安全性更高;可提高月经恢复情况、憩室修复情况。但原始研究质量均较低,建议临床上审慎选择使用;需更多高质量、大样本研究进一步验证。Objective：To asscess the efficacy of the hysteroscopy combined with lapa-roscopy versus the vaginal operation for previous cesarean scar defect （ PCSD ） . Method：The databases such as The Cochrane Central Register of Controlled Trials （ CENTRAL ）、Pubmed、SCIE、EMbase、CNKI、VIP and WanFang Data were searched to collecting the randomized con-trol trials（ RCTs） about the hysteroscopy combined with laparoscopy and vaginal operation for PCSD. The retrieval time was from inception to Dec. 2015. Two reviewers independently screened the literature and assessed the quality of included studies. Then, the meta-analysis were performed by using the RevMan 5. 1 software according to Cochrane Handbook. Results：A total of Fourteen RCTs involving 884 patients were included. The meta-analysis showed that the hysteroscopy combined with laparoscopy operation had longer operation time compared with the vaginal operation[MD=13. 99,95%CI（4. 76,23. 23）,P=0. 003],lesser amount of intraoper-ative bleeding[MD=-13. 08,95%CI（-22. 98,-3. 18）,P=0. 01],shorter hospital stay time [MD=-2. 10,95%CI（-3. 45,-0. 75）,P=0. 002],lower rate of postoperative complications [RR=0. 38,95%CI（0. 19,0. 75）,P=0. 006],shorter postoperative vaginal bleeding time. [MD=-3. 16,95%CI（-5. 26,-1. 05）,P=0. 003],better menstruation recovery[OR=1. 89, 95%CI （ 1 . 11 , 3 . 20 ） , P=0 . 02 ] , more effective uterine incision diverticulum repair [ OR=2. 16,95%CI（1. 20,3. 88）,P=0. 010],more expensive treatment cost[SMD=6. 93,95%CI （4. 50,9. 35）,P〈0. 00001]. Additionaly,there was no significance difference in postoperative anal exhaust[MD=0. 26,95%CI（-0. 22,0. 75,P=0. 29）]. Conclusion：The current evidence indicates that the hysteroscopy combined with laparoscopy surgery is similar to the vaginal oper-ation in postoperative anal exhaust, and lesser intraoperative bleeding than the vaginal opera-tion,longer than the vaginal operation in operation time,more expensive than the vaginal opera-tion in treatment cost, can

关 键 词：剖宫产切口憩室 宫腔镜 腹腔镜 阴式手术 META分析 随机对照试验 

分 类 号：R719.8[医药卫生—妇产科学]