先前剖宫产术后的粘连形成——一项荟萃分析和系统评价。
Adhesion formation after previous caesarean section-a meta-analysis and systematic review.
机构信息
Department of Chemistry, Temple University, Philadelphia, PA, USA.
出版信息
BJOG. 2011 Mar;118(4):410-22. doi: 10.1111/j.1471-0528.2010.02808.x. Epub 2010 Dec 23.
BACKGROUND
The optimal technique for performing caesarean section with respect to minimising postoperative adhesions has not been determined.
OBJECTIVES
To evaluate adhesion formation for three common caesarean section techniques in women undergoing repeat caesarean section surgeries.
SEARCH STRATEGY
A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database and through contact with experts in this field from January 1990 to May 2010.
SELECTION CRITERIA
Studies were included if they examined adhesion formation in repeat caesarean sections as a primary objective, delineated a clear study design, specified an adhesion scoring system, and had sufficient patient exclusion criteria.
DATA COLLECTION AND ANALYSIS
We abstracted data regarding adhesion formation. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio or inverse variance, along with 95% CI.
MAIN RESULTS
Thirty-three qualified studies including 4423 women were analysed. There were 406 adhesions among 571 women and 238 adhesions among 596 women in the Stark's caesarean section (also known as Misgav-Ladach method) group and modified Stark's caesarean section group, respectively, with pooled OR 4.69 (95% CI 3.32-6.62; P < 0.01, 12 studies); 1173 adhesions among 1555 women and 1179 adhesions among 1625 women in Stark's caesarean section group and classic lower-segment caesarean section group, respectively, with pooled odds ratio 1.28 (95% CI 0.97-1.68; P = 0.08, 21 studies); and 29 adhesions from 102 women and 115 adhesions from 193 women in modified Stark's caesarean section group and classic lower-segment caesarean section group, respectively, with pooled odds ratio 0.28 (95% CI 0.10-0.82; P = 0.02, two studies).
AUTHORS' CONCLUSIONS: Closure of the peritoneum in modified Stark's caesarean section resulted in less adhesion formation and should be recommended.
背景
对于减少术后粘连，行剖宫产术的最佳技术尚未确定。
目的
评估三种常见剖宫产术式在再次剖宫产术中的粘连形成情况。
检索策略
从 1990 年 1 月至 2010 年 5 月，通过构建 Medline、EMBASE、Cochrane 图书馆、国家科学数字图书馆、中国生物医学数据库的数据库，并与该领域的专家联系，构建了数据库。
选择标准
如果研究将粘连形成作为主要目标，明确研究设计，规定粘连评分系统，并具有足够的患者排除标准，则纳入研究。
数据收集和分析
我们提取了关于粘连形成的数据。采用 Mantel-Haenszel 随机效应模型对所有分析进行分析，使用比值比或倒数方差，同时使用 95%CI。
主要结果
33 项合格的研究纳入了 4423 名女性。Stark 剖宫产术（也称为 Misgav-Ladach 方法）组和改良 Stark 剖宫产术组中分别有 571 名女性和 596 名女性中有 406 例粘连，238 例粘连，汇总比值比为 4.69（95%CI 3.32-6.62；P<0.01，12 项研究）；Stark 剖宫产术组和经典下段剖宫产术组中分别有 1555 名女性和 1625 名女性中有 1173 例粘连，1179 例粘连，汇总比值比为 1.28（95%CI 0.97-1.68；P=0.08，21 项研究）；改良 Stark 剖宫产术组和经典下段剖宫产术组中分别有 102 名女性和 193 名女性有 29 例粘连和 115 例粘连，汇总比值比为 0.28（95%CI 0.10-0.82；P=0.02，两项研究）。
作者结论
改良 Stark 剖宫产术关腹可减少粘连形成，应予以推荐。
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