倒刺缝线在妇科腔镜手术中应用的Meta分析

Meta-analysis on barbed suture for gynecological surgery

目的系统评价倒刺缝线在妇科腔镜手术中应用的疗效和安全性。方法计算机检索Cochrane图书馆、Pub Med、EMBASE、CBM、CNKI、VIP和万方,均截至2014年9月。全面收集倒刺缝线在妇科腔镜手术中应用的临床试验,采用Cochrane系统评价的方法,提取数据,评价研究质量,并采用Rev Man 5.2软件进行合并分析。结果共纳入5项研究,包括237例患者。Meta分析结果显示,倒刺缝合子宫肌壁时间明显减少了子宫肌壁缝合时间[MD=-5.90,95%CI(-7.70,-4.10)]和术中出血量[MD=-0.47,95%CI(-0.85,-0.08)],降低手术难度[MD=-2.24,95%CI(-3.02,-1.47)]。而在阴道残端时间[MD=-2.95,95%CI(-6.93,1.03)]和总的手术时间[MD=-4.26,95%CI(-10.11,1.58)],两组间差异无统计学意义。在安全性方面,倒刺缝线和普通缝线相比未增加任何不良反应的风险。结论倒刺缝线可以明显减少子宫肌壁缝合时间,减少术中失血量以及妇科腹腔镜手术的难度,同时未增加并发症的风险。而对于其是否可以减少阴道残端的缝合时间,仍需要大样本随机对照试验进一步研究。

【Objectives】To evaluate the clinical efficacy and safty of barbed suture for gynecological surgery.【Methods】We searched the electronic bibliographic databases, including the Cochrane Library, Pub Med, EMbase,CBM, CNKI, VIP database and Wanfang database to assemble relevant clinical trials. The deadline of the retrieval time was September 2014. Data were extracted and evaluated using the methods recommended by Cochrane handbook. The Rev Man 5.2 software was used for meta-analysis. 【Results】Five trials involving 237 patients were included. The results of meta-analysis showed that barbed suture significantly reduced operative time of uterine muscle wall [MD =-5.90, 95%CI（-7.70,-4.10）], and decreased the blood loss [MD =-0.47, 95%CI（-0.85,-0.08）] and the grade of surgery [MD =-2.24, 95%CI（-3.02,-1.47）]. There were no significant difference in aspects of operative time of vaginal stump [MD =-2.95, 95%CI（-6.93, 1.03）] and total operation time [MD =-4.26, 95%CI（-10.11,1.58）]. For safety, barbed suture did not cause more concerns than usual suture. 【Conclusion】Without increasing complications, barbed suture reduced the suturing time of uterine wall, and decreased blood loss and surgical difficulties. While, whether it can also improve the suturing time of vaginal stump, more studies need to be performed in the future.