目的:最近的随机对照试验表明,剖宫产时的子宫闭合技术与短期和长期手术结局之间存在关联,结果各不相同。本系统评价和荟萃分析旨在检查用于剖宫产的缝合材料的类型。
方法:Scopus,PubMed,Cochrane中央控制试验登记册,奥维德,和ClinicalTrials.gov从每个数据库开始到2021年10月进行了搜索。
方法:本综述纳入了所有随机对照试验,这些试验比较了妊娠≥24周低位横行剖宫产术中用于子宫切开术的缝合材料类型,并检查了产妇结局。主要结果是估计失血。次要结果包括额外的手术并发症。
方法:结果总结为平均差或风险比以及相关的95%置信区间。使用Cochrane干预措施系统评价手册评估研究质量,以判断偏倚风险。使用I平方(希金斯I2)测量异质性。
结果:本综述包括7项随机对照试验,其中3人将复丝与倒钩缝合进行了比较(136人vs136人),3比较了复丝与常规单丝缝合线(245对244名参与者),1项试验比较了复丝和铬缝线(4590对4595名参与者)。初步分析显示,复丝和带刺缝合组之间的估计失血量没有差异(平均差,46.2mL;95%置信区间,-13.6至105.9),复丝和常规单丝组之间的血红蛋白浓度变化也没有(平均差,-0.1%;95%置信区间,-0.5至0.3)。次要结果显示倒刺缝合与复丝缝合的手术时间减少(平均差异,1.9分钟;95%置信区间,0.03-3.8)。分析还表明,使用常规单丝与复丝缝合会增加子宫瘢痕厚度(平均差,-1.05mm;95%置信区间,-1.9至-0.2)。
结论:由于数据不足,该荟萃分析不支持特定类型的剖宫产子宫闭合缝合材料。尽管倒刺缝合与手术时间的总体减少有关,使用传统的单丝缝合与子宫瘢痕厚度增加有关,这些差异的临床实用性尚不清楚.需要进一步的随机对照试验来评估不同的缝合材料用于子宫切开术的闭合。
OBJECTIVE: Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic
review and meta-analysis aimed to examine types of suture material used for cesarean delivery.
METHODS: Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021.
METHODS: All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks\' gestation and examined maternal outcomes were included for this
review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications.
METHODS: Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I2).
RESULTS: This
review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2).
CONCLUSIONS: This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure.