Mackeen Awathif Dhanya, Schuster Meike, Berghella Vincenzo
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA.
Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19.
We sought to perform a metaanalysis to synthesize randomized clinical trials of cesarean skin closure by subcuticular absorbable suture vs metal staples for the outcomes of wound complications, pain perception, patient satisfaction, cosmesis, and operating time.
A systematic search was performed using MEDLINE, Cochrane Databases, and ClinicalTrials.gov registries. We included randomized trials comparing absorbable suture vs metal staples for cesarean skin closure. Data were abstracted regarding wound complications, patient pain perception, patient satisfaction, cosmesis as assessed by the physician and patient, and operating time.
Twelve randomized trials with data for the primary outcome on 3112 women were identified. Women whose incisions were closed with suture were significantly less likely to have wound complications than those closed with staples (risk ratio, 0.49; 95% confidence interval [CI], 0.28-0.87). This difference remained significant even when wound complications were stratified by obesity. The decrease in wound complications was largely due to the lower incidence of wound separations in those closed with suture (risk ratio, 0.29; 95% CI, 0.20-0.43), as there were no significant differences in infection, hematoma, seroma, or readmission. There were also no significant differences in pain perception, patient satisfaction, and cosmetic assessments between the groups. Operating time was approximately 7 minutes longer in those closed with suture (95% CI, 3.10-11.31).
For patients undergoing cesarean, closure of the transverse skin incision with suture significantly decreases wound morbidity, specifically wound separation, without significant differences in pain, patient satisfaction, or cosmesis. Suture placement does take 7 minutes longer than staples.
我们试图进行一项荟萃分析，以综合皮下可吸收缝线与金属吻合钉用于剖宫产皮肤缝合的伤口并发症、疼痛感知、患者满意度、美观度和手术时间等结局的随机临床试验。
使用MEDLINE、Cochrane数据库和ClinicalTrials.gov注册库进行系统检索。我们纳入了比较可吸收缝线与金属吻合钉用于剖宫产皮肤缝合的随机试验。提取了有关伤口并发症、患者疼痛感知、患者满意度、医生和患者评估的美观度以及手术时间的数据。
确定了12项随机试验，涉及3112名女性的主要结局数据。与使用吻合钉缝合的女性相比，使用缝线缝合切口的女性发生伤口并发症的可能性显著降低（风险比，0.49；95%置信区间[CI]，0.28 - 0.87）。即使按肥胖分层伤口并发症，这种差异仍然显著。伤口并发症的减少主要是由于使用缝线缝合的患者伤口裂开的发生率较低（风险比，0.29；95% CI，0.20 - 0.43），因为在感染、血肿、血清肿或再次入院方面没有显著差异。两组之间在疼痛感知、患者满意度和美观度评估方面也没有显著差异。使用缝线缝合的患者手术时间大约长7分钟（95% CI，3.10 - 11.31）。
对于接受剖宫产的患者，用缝线缝合横向皮肤切口可显著降低伤口发病率，特别是伤口裂开，在疼痛、患者满意度或美观度方面无显著差异。缝线缝合比使用吻合钉多花费7分钟。
