剖宫产子宫肌层不同缝合方式对妊娠结局影响的Meta分析  

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

作　　者：陈蕊娟 王瑜[2] 陈德新[2] 何荣霞[1] Chen Ruijuan;Wang Yu;Chen Dexin;et al.(The Second Clinical Medical College ,Lanzhou 730030;Department of Obstetrics and Gynecology, the Second Hospital, Lanzhou University, Lanzhou 730030)

机构地区：[1]兰州大学第二临床医学院,兰州730030 [2]兰州大学第二医院妇产科,兰州730030

出　　处：《现代妇产科进展》2017年第11期829-833,共5页Progress in Obstetrics and Gynecology

摘　　要：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。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.

关 键 词：剖宫产 子宫缝合 瘢痕评估 META分析 

分 类 号：R714[医药卫生—妇产科学]