剖宫产术中子宫外置与原位修复的比较：一项随机对照试验。

Uterine exteriorization compared with in situ repair at cesarean delivery: a randomized controlled trial.

作者信息

Coutinho Isabela Cristina, Ramos de Amorim Melania Maria, Katz Leila, Bandeira de Ferraz Alvaro Antônio

机构信息

Instituto Materno-Infantil Prof. Fernando Figueira (IMIP); and Universidade Federal de Pernambuco (UFPE), Recife, Brazil.

出版信息

Obstet Gynecol. 2008 Mar;111(3):639-47. doi: 10.1097/AOG.0b013e31816521e2.

DOI:10.1097/AOG.0b013e31816521e2

PMID:18310366

Abstract

OBJECTIVE

To compare extra-abdominal to intra-abdominal repair of the uterine incision at cesarean delivery.

METHODS

This is a randomized controlled trial conducted at the Instituto Materno-Infantil Prof. Fernando Figueira (Recife, Brazil). Inclusion criteria were indication for cesarean delivery and gestational age of 24 weeks or more. Patients with two or more cesarean deliveries, chorioamnionitis, hemorrhage, inability to consent, and previous abdominal surgery were excluded. Variables analyzed were nausea, vomiting, mean operative time, intraoperative blood loss, number of surgical sutures for uterine repair, postoperative pain evaluated by the visual analog scale, number of postoperative analgesic doses, surgical site infection, and endometritis.

RESULTS

The analysis included 325 patients randomized for exteriorized uterine repair and 312 patients randomized for in situ uterine repair. A significant difference was observed in duration of surgery: lasting less than 45 minutes (44% with exteriorized uterus compared with 35.3% with in situ uterus, P=.02; number needed to treat=12) and less need of sutures (18.2% requiring one suture in the exteriorized group compared with 11.9% in the in situ group, P=.03; number needed to treat=16). The frequency of moderate or severe pain 6 hours after surgery was low [corrected] in women with in situ [corrected] repair (23.1%) when compared to those with the uterus exteriorized [corrected] (32.6%) (P=.026; number needed to treat=11). There was no difference between the groups in relation to other variables.

CONCLUSION

There is no significant difference between extra-abdominal and intra-abdominal repair of the uterine incision at cesarean delivery, but the number of sutures is lower and surgical time is shorter with extra-abdominal repair, although moderate and severe pain at 6 hours is less frequent with in situ uterine repair.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00550888.

摘要

目的

比较剖宫产术中子宫切口的腹外缝合与腹内缝合。

方法

这是一项在费尔南多·菲盖拉妇幼研究所（巴西累西腓）进行的随机对照试验。纳入标准为剖宫产指征且孕周24周或以上。排除有两次或更多次剖宫产史、绒毛膜羊膜炎、出血、无法签署知情同意书以及既往有腹部手术史的患者。分析的变量包括恶心、呕吐、平均手术时间、术中失血、子宫修复的手术缝线数量、采用视觉模拟量表评估的术后疼痛、术后镇痛剂量、手术部位感染及子宫内膜炎。

结果

分析纳入了325例随机接受子宫外置修复的患者和312例随机接受原位子宫修复的患者。观察到手术时长存在显著差异：手术持续时间少于45分钟（子宫外置组为44%，原位子宫组为35.3%，P = 0.02；需治疗人数 = 12），且缝线需求较少（外置组18.2%需要一针缝线，原位组为11.9%，P = 0.03；需治疗人数 = 16）。与子宫外置修复的女性相比，原位修复的女性术后6小时中度或重度疼痛的发生率较低（23.1%）（子宫外置组为32.6%）（P = 0.026；需治疗人数 = 11）。两组在其他变量方面无差异。