Topsoee Märta F, Settnes Annette, Ottesen Bent, Bergholt Thomas
Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark.
Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Int J Gynaecol Obstet. 2017 Feb;136(2):120-127. doi: 10.1002/ijgo.12047. Epub 2016 Dec 9.
The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear.
To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery.
PubMed, Embase, Cochrane Library, and Web of Science were searched from 1980 to 2015 without language restriction using search terms related to major uterine surgery combined with TA.
Randomized controlled trials comparing prophylactic TA with placebo or no intervention in women undergoing elective major benign uterine surgery.
Basic information and outcomes were collected and meta-analyses performed.
Sixteen trials were included, with five trials considered to have an overall low risk of bias. In cesarean delivery, TA significantly reduced intraoperative bleeding (mean -136 mL, 95% confidence interval [CI] -189 to -83), blood loss of more than 1000 mL (relative risk 0.38, 95% CI 0.18-0.81), and blood transfusion (relative risk 0.32, 95% CI 0.17-0.59). In abdominal myomectomy, TA also significantly reduced intraoperative bleeding (mean -251 mL, 95% CI -391 to -110).
Prophylactic TA treatment significantly reduced operative bleeding in women undergoing elective cesarean delivery or abdominal myomectomy. Additional randomized trials with low risk of bias are needed.
氨甲环酸（TA）治疗在重大子宫手术中作为出血预防措施的价值尚不清楚。
评估预防性TA治疗在重大良性子宫手术中的抗出血效果。
使用与重大子宫手术及TA相关的检索词，于1980年至2015年对PubMed、Embase、Cochrane图书馆和科学网进行检索，无语言限制。
比较预防性TA与安慰剂或对接受择期重大良性子宫手术的女性不进行干预的随机对照试验。
收集基本信息和结果并进行荟萃分析。
纳入16项试验，其中5项试验被认为总体偏倚风险较低。在剖宫产中，TA显著减少术中出血（平均-136 mL，95%置信区间[CI]-189至-83）、出血量超过1000 mL（相对风险0.38，95% CI 0.18 - 0.81）和输血（相对风险0.32，95% CI 0.17 - 0.59）。在腹部子宫肌瘤切除术中，TA也显著减少术中出血（平均-251 mL，95% CI -391至-110）。
预防性TA治疗显著减少了接受择期剖宫产或腹部子宫肌瘤切除术女性的手术出血。需要更多偏倚风险低的随机试验。
