Zayed Mohamed A, Fouda Usama M, Elsetohy Khaled A, Zayed Shereef M, Hashem Ahmed T, Youssef Mohamed A
a Department of Obstetrics and Gynecology, Faculty of Medicine , Cairo University , Cairo , Egypt.
J Matern Fetal Neonatal Med. 2019 Mar;32(5):710-717. doi: 10.1080/14767058.2017.1388368. Epub 2017 Oct 29.
The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX™ Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL; Ethicon Inc.).
One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous.
The uterine closure time was significantly lower in the Stratafix group (224 ± 46 versus 343 ± 75 s, p < .001). Operative time was comparable between both groups. Twelve patients in the Vicryl group and two patients in the Stratafix group required additional sutures to achieve hemostasis (p value = .009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance.
The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).
本随机对照试验的目的是比较使用倒刺缝线（STRATAFIX™ 螺旋聚对二氧环己酮免打结组织控制装置，SXPD2B405，爱惜康公司）缝合子宫切口的剖宫产手术数据和术后早期结果与使用传统光滑缝线（薇乔；爱惜康公司）缝合子宫切口的剖宫产手术数据和术后早期结果。
100例孕妇按1:1比例随机分为倒刺缝线组或薇乔缝线组。两组均采用两层缝线缝合子宫切口。薇乔缝线组，第一层为连续缝合，第二层为间断缝合。倒刺缝线组，两层均为连续缝合。
倒刺缝线组子宫关闭时间显著缩短（224±46秒对343±75秒，p<0.001）。两组手术时间相当。薇乔缝线组12例患者和倒刺缝线组2例患者需要额外缝合以实现止血（p值=0.009）。倒刺缝线组子宫切口关闭期间的平均失血量和平均住院时间较低，但这些差异未达到统计学意义。
剖宫产时使用倒刺缝线缝合子宫切口与传统光滑缝线相比，子宫关闭时间更短，围手术期早期并发症相似。两组在子宫切口第二层缝合技术上的差异可能是倒刺缝线缝合子宫切口时子宫关闭时间缩短以及需要额外缝合以实现止血的原因。此外，应进行设计良好的随机对照试验，以研究缝线类型（倒刺或传统光滑）与剖宫产远期并发症（不孕、盆腔疼痛、胎盘异常和子宫破裂）之间的关联。
