缝合方式对剖宫产术后憩室形成影响的系统评价

A systematic review of the effect of suture method on the formation of diverticulum after cesarean section

目的评价与评估子宫缝合方式对剖宫产术后憩室形成的影响。方法检索pubmed、Cochrane、Embase、Sinomed、CNKI、VIP、万方等数据库,检索时限为建库至2019年10月21日,收集缝合方式影响剖宫产术后憩室形成的相关文献。采用Review 5.3软件进行Meta分析。结果纳入评价文章28篇,纳入单双层缝合Meta分析14篇,纳入全层分层缝合Meta分析8篇。其中1 282例采用双层缝合,1 267例采用单层缝合,755例采用全层缝合,741例采用分层缝合。Meta分析结果显示,与单层缝合相比,采用双层缝合患者憩室形成率低(Z=5.21,OR 0.39,95%CI 0.27-0.56,P<0.001),憩室肌层厚(Z=3.82,OR 1.31,95%CI 0.64-1.98,P<0.001),憩室容积小(Z=10.68,OR-0.16,95%CI-0.19--0.13,P<0.001),手术时间长(Z=3.53,OR 0.76,95%CI 0.34-1.17,P=0.0004),术中出血量无明显差异(Z=1.36,OR-1.76,95%CI-4.30-0.79,P=0.18),住院时间无明显差异(Z=1.21,OR-0.20,95%CI-0.52-0.12,P=0.23)。与分层缝合相比,全层缝合患者,其憩室形成率低(Z=6.48,OR 0.36,95%CI 0.26-0.49,P<0.001),手术时间无明显差异(Z=0.78,OR 0.52,95%CI-0.78-1.81,P=0.43)。结论子宫切口双层缝合法虽然手术时间长,但能降低子宫瘢痕憩室的形成率。且憩室容积小,憩室肌层厚,理论上能减少子宫瘢痕憩室带来的各种并发症。子宫切口全层缝合也能降低子宫瘢痕憩室形成率。

Objective To evaluate the effect of uterine suture on the formation of diverticulum after cesarean section.Methods We searched pubmed,Cochrane,Embase,Sinomed,CNKI,VIP,Wanfang and other databases.The search time limit was database construction to October 21,2019,to collect relevant literatures about the effect of suture on the formation of diverticulum after cesarean section.Used Review 5.3 software for Meta analysis.Results 28 review articles were included,14 single-layer and double-layer suture Meta analyses were included,and 8 full-layer and layered suture Meta analyses were included.Among them,1282 cases used double-layer suture,1267 cases used single-layer suture,755 cases used full-layer suture,and 741 cases used layered suture.Meta analysis results showed that compared with single-layer suture,patients with double-layer suture had lower diverticulum formation rate(Z=5.21,OR 0.39,95%CI 0.27-0.56,P<0.001),and thicker diverticulum muscle layer(Z=3.82,OR 1.31,95%CI 0.64-1.98,P<0.001),smaller diverticulum volume(Z=10.68,OR-0.16,95%CI-0.19--0.13,P<0.001),longer operation time(Z=3.53,OR 0.76,95%CI 0.34-1.17,P=0.0004),no significant difference in intraoperative blood loss(Z=1.36,OR-1.76,95%CI-4.30-0.79,P=0.18),no significant difference in hospital stay(Z=1.21,OR-0.20,95%CI-0.52-0.12,P=0.23).Compared with layered suture,patients with full-thickness suture had lower diverticulum formation(Z=6.48,OR 0.36,95%CI 0.26-0.49,P<0.001),and no significant difference in operation time(Z=0.78,OR 0.52,95%CI-0.78-1.81,P=0.43).Conclusion Despite the long operation time,the double-layer suture method for uterine incision can reduce the formation rate of uterine scar diverticulum.And the volume of the diverticulum is small,and the muscular layer of the diverticulum is thick,which can theoretically reduce various complications caused by uterine scar diverticulum.Full-thickness uterine incision suture can also reduce the formation rate of uterine scar diverticulum.