Mackeen A Dhanya, Berghella Vincenzo, Larsen Mie-Louise
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas JeffersonUniversity, Philadelphia, Pennsylvania, USA.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD003577. doi: 10.1002/14651858.CD003577.pub2.
Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples. A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women.
To compare the effects of skin closure techniques and materials on maternal and operative outcomes after caesarean section.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 January 2012).
All randomized trials comparing different skin closure materials in caesareans were selected. Two review authors independently extracted the data.
We identified 18 trials and included 10, but only eight trials contributed data. Three trials were not randomized controlled trials; three were ongoing; and one did not compare skin closure materials, but rather suture to suture and drain placement.
The two methods of skin closure for caesarean that have been most often compared are non-absorbable staples and absorbable subcutaneous sutures. Compared with absorbable subcutaneous sutures, non-absorbable staples are associated with similar incidences of wound infection. Other important secondary outcomes, such as wound complications, were also similar between the groups in women with Pfannenstiel incisions. However, it is important to note, that for both of these outcomes (wound infection and wound complication), staples may have a differential effect depending on the type of skin incision, i.e., Pfannenstiel or vertical. Compared with absorbable subcutaneous sutures, non-absorbable staples are associated with an increased risk of skin separation, and therefore, reclosure. However, skin separation was variably defined across trials, and most staples were removed before four days postpartum.
AUTHORS' CONCLUSIONS: There is currently no conclusive evidence about how the skin should be closed after caesarean section. Staples are associated with similar outcomes in terms of wound infection, pain and cosmesis compared with sutures, and these two are the most commonly studied methods for skin closure after caesarean section. If staples are removed on day three, there is an increased incidence of skin separation and the need for reclosure compared with absorbable sutures.
剖宫产是一种常见手术，在某些手术技术或使用的材料方面尚无公认的标准。关于皮肤缝合，皮肤切口可通过皮肤层下方的皮下连续缝合、间断缝合或钉合来重新对合。剖宫产术后皮肤缝合使用了各种各样的材料和技术，有必要确定哪种方法能为女性带来最佳效果。
比较剖宫产术后皮肤缝合技术和材料对产妇及手术结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年1月10日）。
选取所有比较剖宫产中不同皮肤缝合材料的随机试验。两位综述作者独立提取数据。
我们识别出18项试验，纳入了10项，但只有8项试验提供了数据。3项试验不是随机对照试验；3项正在进行；1项未比较皮肤缝合材料，而是比较了缝线与缝线及引流管放置情况。
剖宫产中最常被比较的两种皮肤缝合方法是非吸收性钉合和可吸收皮下缝合。与可吸收皮下缝合相比，非吸收性钉合的伤口感染发生率相似。对于采用耻骨联合上横切口的女性，两组间其他重要的次要结局，如伤口并发症，也相似。然而，需要注意的是，对于这两种结局（伤口感染和伤口并发症），钉合的效果可能因皮肤切口类型（即耻骨联合上横切口或纵切口）而异。与可吸收皮下缝合相比，非吸收性钉合导致皮肤分离及因此需要再次缝合的风险增加。不过，各试验对皮肤分离的定义不一，且大多数钉合在产后四天前拆除。
目前尚无关于剖宫产术后皮肤应如何缝合的确凿证据。与缝线相比，钉合在伤口感染、疼痛和美观方面的结局相似，这两种是剖宫产术后最常被研究的皮肤缝合方法。如果在术后第三天拆除钉合，与可吸收缝线相比，皮肤分离的发生率增加且需要再次缝合。
