背景:宫颈机能不全(CI)可能导致早产。我们试图进行此回顾和分析,以比较腹腔镜和开腹环扎术(TAC)在CI患者中的疗效。
方法:我们的搜索包括PubMed,Scopus,MEDLINE,临床试验。政府,Cochrane和WebofScience。我们使用OpenMeta-Analyst软件和ReviewManager软件对数据进行了分析。我们纳入了观察性和随机对照试验,包括接受腹腔镜环扎或TAC的CI患者。
结果:我们共纳入了43项研究。腹腔镜和TAC通过增加孕龄(GA)产生积极作用;对于腹腔镜组(平均偏差(MD))=14.86周(W),95%CI[10.67,19.05],P<0.001)和TAC(MD=12.79W,95%CI[10.97,14.61],P<0.001)。此外,评估的所有结局的改善(胎儿总存活率,新生儿体重,和预防胎龄<24周的分娩)均具有重要意义,但预防所有早产<37周的除外;对于两种腹腔镜(RR=0.116,95%CI[-0.006,0.238],P=0.063)和TAC在(MD=1,95%CI[0.45,2.24],P=1),以及腹腔镜组<34周的分娩预防(RR=0.446,95%CI[-0.323,1.215],仅P=0.256)。
结论:尽管有限的数据阻止了妊娠和孕前亚组以及头对头比较,我们仍然发现,在患有CI的患者中,TAC和腹腔镜环扎术在保留妊娠方面均显示出积极的效果.
BACKGROUND: Cervical insufficiency (CI) may result in preterm delivery. We sought out to perform this
review and analysis to compare the efficacy of laparoscopic and open transabdominal cerclage (TAC) in patients suffering with CI.
METHODS: Our search included PubMed, Scopus, MEDLINE, ClinicalTrials.Gov, Cochrane and Web of Science. We analyzed the data with Open Meta-Analyst Software as well as
Review Manager Software. We included observational and randomized controlled trials that included patients with CI that underwent laparoscopic cerclage or TAC.
RESULTS: We included a total of 43 studies. Laparoscopic and TAC had a positive effect by increasing gestational age (GA); for the laparoscopic group (mean deviation (MD)) = 14.86 weeks (W), 95% CI [10.67, 19.05], P < 0.001) and TAC (MD = 12.79 W, 95% CI [10.97, 14.61], P < 0.001). Furthermore, improvements in all outcomes assessed (total fetal survival rate, neonatal weight, and prevention of delivery at a gestational age of<24 weeks) were all significant with the exception of the prevention of all preterm deliveries<37 weeks; for both laparoscopic at (RR = 0.116, 95% CI [-0.006, 0.238], P = 0.063) and TAC at (MD = 1, 95% CI [0.45, 2.24], P = 1), and for prevention of deliveries<34 weeks for the laparoscopic group (RR = 0.446, 95% CI [-0.323, 1.215], P = 0.256) only.
CONCLUSIONS: Although limited data prevented pregnancy and prepregnancy subgroups as well as a head-to-head comparison, we still found that in patients suffering from CI, both TAC and laparoscopic approaches to cerclage revealed a positive effect in preserving the pregnancy.