限制性会阴切开与常规会阴切开对产妇及新生儿预后影响的meta分析

Prognosis Effects of Restrictive Episiotomy Versus Routine Episiotomy on Puerpera and Newborn : a Meta Analysis

目的评价限制性会阴切开(restrictive episiotomy,REE)与常规会阴切开(routine episiotomy,ROE)对产妇及新生儿预后的影响。方法检索并筛选Pub Med、Embase、Cochrane Library、中国知网全文数据库(CNKI)、万方数据库及中国维普全文数据库(VIP)从创建到2016年8月关于REE与ROE对产妇及新生儿预后影响的随机对照试验(RCT)文献。应用Rev Man 5.3.1软件对筛选出的文献进行meta分析。结果本研究共纳入文献15篇,涉及病例6377例。meta分析结果显示,限制组Ⅰ、Ⅱ度会阴裂伤率高于常规组[RR=6.24,95%CI(1.85,21.04),P=0.003],第二产程时间略长于常规组[MD=1.45,95%CI(0.28,2.61),P=0.01],但限制组在降低会阴切开率[RR=0.35,95%CI(0.28,0.43),P<0.00001]、提高会阴完整率[RR=2.43,95%CI(1.12,5.24),P=0.02]、减少产时出血量[MD=-32.02,95%CI(-61.42,-2.62),P=0.03]、降低产后严重会阴疼痛发生率[RR=0.37,95%CI(0.27,0.51),P<0.00001]、降低产后性生活障碍发生率[RR=0.38,95%CI(0.24,0.58),P<0.0001]、降低产后其他并发症发生率[RR=0.54,95%CI(0.36,0.80),P=0.002]及缩短产后住院时间[MD=-0.89,95%CI(-1.44,-0.35),P=0.001]等方面优于常规组。结论本研究结果说明,较ROE而言,REE可减轻创伤、加快术后恢复、提高患者生活质量,且对新生儿无影响,但本研究纳入文献质量不高,临床仍有必要开展此方面高质量、大样本、多中心的随机对照试验研究来对该结论进行验证。

Objective To evaluate effects of restrictive episiotomy （REE） and routine episiotomy （ROE） on prognosis of puerpera and newborn. Methods All randomized controlled trials （RCTs） papers concerning BEE and ROE on prog- nosis of puerpera and newborn were retrieved and chosen from PubMed, Embase, Coehrane Library, CNKI, Wanfang database and VIP full-text database （VIP） during establishment and Augest 2016. Meta-analysis was conducted by using the statistical software RevMan 5.3.1. Results A total of 15 papers （6377 patients） were included in the study. Meta analysis showed that grade Ⅰ and Ⅱ perineal laceration rate in REE group was higher than that in ROE group [RR =6. 24, 95% CI （ 1.85, 21.04）, P = 0. 003 ]. In REE group, duration of the second stage of labor was slightly longer than that in ROE group [ MD = 1.45, 95% CI （0.28, 2.61 ） , P = 0.011 ; perinaeum incision rate was decreased [ RR = 0.35, 95% CI （0.28,0.43） , P 〈 0. 00001 ] ; perinaeum integrity rate was significantly increased [ RR = 2.43, 95% CI （ 1.12, 5.24, P = 0.021 ; intrapartum bleeding volume was significantly reduced [ MD = -32.02,95% CI （ -61.42, -2.62）, P = 0. 03 ] ; incidence rate of seri- ous postpartum perineal pain was significantly decreased [ RR =0.37, 95% CI（0.27,0.51 ）, P 〈0. 00001 ] ; incidence rates of the maternal postpartum sexual dysfunction was decreased [ RR = 0.38, 95% CI （0.24,0.58）, P 〈 0. 0001 ] ; incidence rate of other postpartum complications [ RR =0.54, 95% CI （0.36,0.80）, P = 0. 002] and value of hospital stay [ MD = -0.89, 95% CI （ -1.44, -0.35）, P=0.001] were superior to those in ROE group. Conclusion The study shows that restrictive episiotomy can relieve wound, promote postoperative recovery and improve postoperative quality of life without effects on newborn compared with those by ROE. However, available papers are not adequate to draw a conclusion due to the methodological flaws of the included trials, while high quality, large sample and multicenter randomized controlled trials are needed to confirm the findings.