选择性剖宫产和阴道顺产对初产妇产后早期盆底功能影响Meta分析

Meta-analysis of the effect of two different delivery methods on the pelvic floor function in the early postpartum

目的系统评价选择性剖宫产和阴道顺产两种不同分娩方式对初产妇产后早期盆底功能的影响。方法以"选择性剖宫产"、"阴道顺产(分娩)"、"盆底功能"、"随机"等关键词检索2015年12月以前Pub Med、Embase、Cochrane Library、VIP、万方、CNKI等数据库,由两位评价者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,依据Cochrane系统评价方法,采用系统评价专用软件Rev Man5.2对所提取的数据进行Meta分析。结果共纳入13个符合要求的随机对照试验研究,经JADAD量表评分均≥3分。共计1365例初产妇,其中选择性剖宫产693例,阴道顺产672例。Meta分析结果显示:两种不同分娩方式的盆底肌检测、会阴超声膀胱颈角度、膀胱颈旋转角度、压力性尿失禁(SUI)发生率、盆腔器官脱垂(POP)发生率比较,差异均有统计学意义(P<0.05)。选择性剖宫产可降低初产妇产后早期POP的发生率,并可减少发生SUI的风险。结论选择性剖宫产相较于阴道顺产对盆底功能的影响更小,在一定程度上降低了对盆底肌肉的损伤,但剖宫产不能完全避免盆底功能障碍性疾病的发生,故不能以此作为选择性剖宫产的依据。

Objective To evaluate the effect of two different delivery methods on the pelvic floor function in the early postpartum. Methods Based on the keywords of ＂Selective Cesarean Section＂, ＂Vaginal Delivery＂, ＂Pelvic Floor＂and ＂Randomized Controlled Trial＂, the Cochrane systematic review method was used to search on PubMed, Embase, Co- chrane Library, VIP, Wanfang and CNKI database published before December 2015. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality. Then the Meta-analysis was conducted by using Revman5.2 software.Results Totally 13 RCTs were included, 1365 pa- tients in total, of which 693 cases in the selective cesarean section group, 672 cases in the vaginal delivery group. Based on the JADAD scale of evaluation system, all of the trials reached score〉3 points. According to Meta-analysis showed that, the occurrence of SUI,POP,pelvic floor muscle strength and bladder neck mobility had statistical differences be- tween the two groups （P 〈 0.05 ）.Selective cesarean section could reduce the incidence of postpartum early pelvic viscera prolapsed and stress urinary incontinence. Conclusion In comparison, selective desarean section can reduce the impact on pelvic floor function, and may reduce the impact on pelvic floor muscle strength at a certain extent compared with vagi- nal delivery, but it can＇t completely avoid the incidence of pelvic floor dysfunction, so it can＇t be considered to be the best choice.