剖宫产术中子宫外置与子宫切口原位修复的随机对照试验。

A randomized controlled trial of uterine exteriorization versus in situ repair of the uterine incision during cesarean delivery.

作者信息

El-Khayat Waleed, Elsharkawi Mohamed, Hassan Amr

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

出版信息

Int J Gynaecol Obstet. 2014 Nov;127(2):163-6. doi: 10.1016/j.ijgo.2014.05.004. Epub 2014 Jun 19.

DOI:10.1016/j.ijgo.2014.05.004

PMID:25005057

Abstract

OBJECTIVE

To compare extra-abdominal repair of the uterine incision at cesarean delivery with in situ repair.

METHODS

The present study was a double-blind randomized controlled trial conducted at a university hospital in Egypt during 2012-2013, and included women with an indication for cesarean delivery. Extra-abdominal repair was used in group 1 (n=500) and in situ repair in group 2 (n=500). The primary outcome measure was the surgery duration.

RESULTS

Surgery duration was significantly longer in group 1 than group 2 (49.9±2.3 minutes vs 39.9±1.8 minutes; P<0.001). More patients in group 1 than in group 2 had postoperative moderate-to-severe pain (165 [33.0%] vs 115 [23.0%]; P=0.001) and needed additional postoperative analgesia (100 [20.0%] vs 50 [10.0%]; P<0.001). Moreover, mean time to bowel movement was longer in group 1 than in group 2 (17.0±2.7 hours vs 14.0±1.9 hours; P<0.001).

CONCLUSION

In situ uterine closure is more advantageous than extra-abdominal repair in terms of surgery duration, postoperative pain and need for additional analgesia, and return of bowel movement. ClinicalTrials.gov:NCT01723605.

摘要

目的

比较剖宫产术中子宫切口的腹外缝合与原位缝合。

方法

本研究为双盲随机对照试验，于2012 - 2013年在埃及一家大学医院开展，纳入有剖宫产指征的女性。第1组（n = 500）采用腹外缝合，第2组（n = 500）采用原位缝合。主要观察指标为手术时长。

结果

第1组的手术时长显著长于第2组（49.9±2.3分钟 vs 39.9±1.8分钟；P<0.001）。第1组术后中重度疼痛的患者多于第2组（165例[33.0%] vs 115例[23.0%]；P = 0.001），且术后需要额外镇痛的患者也更多（100例[20.0%] vs 50例[10.0%]；P<0.001）。此外，第1组的平均排便时间长于第2组（17.0±2.7小时 vs 14.0±1.9小时；P<0.001）。