宫颈环扎术联合子宫颈托对宫颈机能不全患者临床疗效的meta分析  

The clinical efficacy of cervical cerclage combined with pessary in patients with cervical insufficiency:a meta analysis.

作　　者：杜凌君 林琳[1] 黄明莉[1] Du Lingjun;Lin Lin;Huang Mingli(Department of Obstetrics,the First Affiliated Hospital of Harbin Medical University,Harbin 150000)

机构地区：[1]哈尔滨医科大学附属第一医院产科,哈尔滨150000

出　　处：《现代妇产科进展》2024年第5期332-339,共8页Progress in Obstetrics and Gynecology

摘　　要：目的:运用meta分析的方法比较宫颈环扎术联合宫颈托与单独行宫颈环扎术在宫颈机能不全患者早产预防方面的临床疗效,为临床诊疗提供循证医学证据。方法:计算机检索知网、万方、PubMed、Web of Science、Cochrane Library数据库自建库至2023年10月1日所有相关文献,由2位研究人员根据纳入与排除标准独立地进行文献筛选、数据提取和质量评价,使用Review Manager (RevMan)(Computer program).Version 5.4.1进行数据分析,比较宫颈环扎术联合宫颈托组与单独使用宫颈环扎术组在妊娠小于34周早产、妊娠小于37周早产、妊娠小于32周早产、妊娠小于28周流产发生率及新生儿NICU入院率、新生儿出生体重、剖宫产率、延长妊娠天数等方面的差异。结果:共检出1477篇可能相关文章,通过阅读摘要、删除重复文献,最终纳入5篇文献进入meta分析。宫颈环扎术后联合使用宫颈托组与单独行宫颈环扎术组相比,在妊娠小于34周早产率(OR=0.83,95%CI为0.42~1.63,P=0.59)、妊娠小于37周早产率(OR=0.90,95%CI为0.55~1.46,P=0.66)、妊娠小于32周早产率(OR=0.52,95%CI为0.25~1.07,P=0.08)、妊娠小于28周流产率(OR=0.53,95%CI为0.21~1.32,P=0.17)、新生儿NICU入院率(OR=0.77,95%CI为0.44~1.36,P=0.37)、新生儿出生体重(MD=37.97,95%CI为-263.97~339.92,P=0.81)、剖宫产率(OR=1.22,95%CI为0.50~2.99,P=0.67)、延长妊娠天数(MD=16.09,95%CI为-8.41~40.32,P=0.19)等方面差异均无统计学意义。宫颈机能不全患者中伴有羊膜囊膨出的患者单独进行meta分析,结果显示宫颈环扎术联合宫颈托组与单独使用宫颈环扎术组在延长妊娠天数(MD=37.39,95%CI为15.98~58.79,P=0.0006)、增加新生儿出生体重(MD=722.58,95%CI为145.96~1299.20,P=0.01)、减少妊娠小于32周早产发生率(OR=0.20,95%CI为0.06~0.64,P=0.007)等方面差异均有统计学意义。结论:宫颈环扎术前伴有羊膜囊膨出的患者中,宫颈环扎术后联合使用子宫颈托与单独Objective:To compare the clinical efficacy of cervical cerclage combined with pessary versus cervical cerclage alone in the prevention of preterm labour in patients with cervical insufficiency by using meta-analysis,and to provide evidence-based medical evidence for clinical diagnosis and treatment.Methods:A computerised search of five databases,including CNKI,Wanfang,PubMed,Web of Science,and Cochrane Library,was carried out for all the relevant literature since its inception until 2023-10-1.Two researchers independently performed the literature screening,data extraction,and quality assessment based on the inclusion criteria and exclusion criteria.Data were analysed using Review Manager Version 5.4.1 to compare the incidence of preterm birth at less than 34 weeks of gestation,preterm birth at less than 37 weeks of gestation,preterm birth at less than 32 weeks of gestation,miscarriage at less than 28 weeks of gestation,and the rates of neonatal NICU admissions,neonatal birth weights,caesarean sections,and days of prolonged gestation in the combined group and the cerclage alone group.Results:A total of 1477 potentially relevant articles were retrieved,and after reading the abstracts and deleting duplicates,a total of 5 articles were included in this meta-analysis.Comparing with the cervical cerclage alone group,the combined use of a pessary and cervical cerclage group showed no differences in the preterm birth rate at less than 34 weeks of gestation(OR=0.83,95%CI 0.42~1.63,P=0.59),preterm birth rate at less than 37 weeks of gestation(OR=0.90,95%CI 0.55~1.46,P=0.66),preterm birth rate at less than 32 weeks of gestation(OR=0.52,95%CI 0.25~1.07,P=0.08),miscarriage rate at less than 28 weeks gestation(OR=0.53,95%CI 0.21~1.32,P=0.17),neonatal NICU admission rate(OR=0.77,95%CI 0.44~1.36,P=0.37),neonatal birth weight(MD=37.97,95%CI-263.97~339.92,P=0.81),cesarean section rate(OR=1.22,95%CI 0.50~2.99,P=0.67),prolonged gestation days(MD=16.09,95%CI-8.41~40.32,P=0.19).However,when the patients with dilated amniotic sac was a

关 键 词：宫颈环扎术 宫颈托 早产 META分析 

分 类 号：R711.7[医药卫生—妇产科学]