Kettle Christine, Dowswell Therese, Ismail Khaled Mk
Maternity Centre, University Hospital of North Staffordshire, City General Site, Newcastle Road, Stoke-on-Trent, Staffordshire, UK, ST4 6QG.
Cochrane Database Syst Rev. 2010 Jun 16;2010(6):CD000006. doi: 10.1002/14651858.CD000006.pub2.
Approximately 70% of women will experience perineal trauma following vaginal delivery and will require stitches. This may result in pain, suture removal and superficial dyspareunia.
To assess the effects of different suture materials on short- and long-term morbidity following perineal repair.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).
Randomised trials comparing different suture materials for perineal repair after vaginal delivery.
Two review authors independently assessed trial quality and extracted data.
We included 18 trials with 10,171 women; comparisons included: catgut with standard synthetic (nine trials), rapidly absorbing synthetic (two trials), and glycerol impregnated catgut sutures (two trials); and standard synthetic sutures with rapidly absorbing synthetic (five trials) and monofilament sutures (one trial).Compared with catgut, standard synthetic sutures were associated with less pain up to three days after delivery (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90); and less analgesia up to ten days postpartum (RR 0.71, 95% CI 0.59 to 0.87). More women with catgut sutures required resuturing (15/1201) compared with synthetic sutures (3/1201) (RR 0.25, 95% CI 0.08 to 0.74); while more women with standard synthetic sutures required the removal of unabsorbed suture material (RR 1.81, 95% CI 1.46 to 2.24). Comparing standard synthetic with rapidly absorbing sutures, short- and long-term pain were similar; in one trial fewer women with rapidly absorbing sutures reported using analgesics at 10 days (RR 0.57, 95% CI 0.43 to 0.77). More women in the standard synthetic suture group required suture removal compared with those in the rapidly absorbed group (RR 0.24, 95% CI 0.15 to 0.36). There was no evidence of significant differences between groups for long-term pain (three months after delivery) or for dyspareunia at three, or at six to 12 months. When catgut and glycerol impregnated catgut were compared, results were similar for most outcomes, although the latter was associated with more short-term pain. One trial examining monofilament versus standard polyglycolic sutures found no differences for most outcomes.
AUTHORS' CONCLUSIONS: Catgut may increase short-term pain compared with synthetic sutures. There were few differences between standard and rapidly absorbing synthetic sutures but more women needed standard sutures removing. For other materials, there was insufficient evidence to draw conclusions. Findings should be interpreted in the context of the related Cochrane review on suturing techniques.
约70%的女性在阴道分娩后会发生会阴创伤，需要缝合。这可能导致疼痛、拆线以及浅表性交困难。
评估不同缝合材料对会阴修补术后短期和长期发病率的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年2月）。
比较阴道分娩后会阴修补使用不同缝合材料的随机试验。
两位综述作者独立评估试验质量并提取数据。
我们纳入了18项试验，涉及10171名女性；比较内容包括：肠线与标准合成缝线（9项试验）、快速吸收合成缝线（2项试验）以及甘油浸渍肠线（2项试验）；标准合成缝线与快速吸收合成缝线（5项试验）以及单丝缝线（1项试验）。与肠线相比，标准合成缝线在产后三天内疼痛较轻（风险比（RR）0.83，95%置信区间（CI）0.76至0.90）；产后十天内镇痛需求较少（RR 0.71，95% CI 0.59至0.87）。与合成缝线（3/1201）相比，更多使用肠线缝合的女性需要再次缝合（15/1201）（RR 0.25，95% CI 0.08至0.74）；而更多使用标准合成缝线的女性需要拆除未吸收的缝线材料（RR 1.81，95% CI 1.46至2.24）。比较标准合成缝线与快速吸收缝线，短期和长期疼痛相似；在一项试验中，较少使用快速吸收缝线的女性在10天时报告使用镇痛药（RR 0.57，95% CI 0.43至0.77）。与快速吸收组相比，标准合成缝线组更多女性需要拆线（RR 0.24，95% CI 0.15至0.36）。没有证据表明两组在长期疼痛（产后三个月）或在三个月、六个月至十二个月时的性交困难方面存在显著差异。当比较肠线和甘油浸渍肠线时，大多数结局的结果相似，尽管后者与更多短期疼痛相关。一项比较单丝缝线与标准聚乙醇酸缝线的试验发现，大多数结局没有差异。
与合成缝线相比，肠线可能会增加短期疼痛。标准合成缝线与快速吸收合成缝线之间差异不大，但更多女性需要拆除标准缝线。对于其他材料，没有足够证据得出结论。研究结果应结合Cochrane关于缝合技术的相关综述来解释。
