Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
County Durham and Darlington NHS Foundation Trust, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:209-214. doi: 10.1016/j.ejogrb.2018.06.037. Epub 2018 Jun 25.
O-ring retractors (Alexis/Mobius) have been shown to reduce the risk of Surgical site infection (SSI) following general abdominal surgery. The benefit at caesarean section (CS) remains to be established given the relatively high cost.
To assess the efficacy of O-ring retractors when used at CS.
Systematic review and meta-analysis. Electronic databases were searched from inception of each database until January 2018. No language restrictions were applied. All randomised controlled trials (RCTs) which compared the use of an O-ring retractor to routine care at CS were included. Primary outcome was SSI. Secondary outcomes were operating time, estimated blood loss, need for blood transfusion, need to exteriorise the uterus, requirement for additional postoperative analgesia and adequate operative field visualisation. Analysis was performed using Revman 5.3.
6 RCTs were included in the qualitative synthesis and the meta-analysis. This included 1669 women. The use of O-ring retractors did not reduce the risk of SSI when used at CS RR 0.76 (95% CI 0.34-1.70). Nor did the use of O-ring retractors reduce the operating time, estimated blood loss, the need for blood transfusion or the need for additional postoperative analgesia. The use O-ring retractors did reduce the need for exteriorisation of the uterus RR 0.48 (95% CI 0.33-0.69), and did increase the rate of adequate visualisation of the operative field RR 1.05 (95% CI 1.00-1.10). In a planned subgroup analysis there was a reduction in the rate of SSI with the use of O-ring retractors in women with a BMI < 35 RR 0.34(95% CI 0.12-0.98).
This review has shown that O-ring retractors do not reduce the incidence of the common measurable complications of CS; SSI, blood loss, need for blood transfusion and need for additional postoperative analgesia. There may be a subgroup where these retractors are useful, but present evidence does not justify their routine use at CS.
评估剖宫产术中使用 O 型环牵开器的效果。
系统评价和荟萃分析。从每个数据库的创建开始，在 2018 年 1 月之前，对电子数据库进行了搜索。没有应用语言限制。所有比较 O 型环牵开器与剖宫产常规护理使用的随机对照试验（RCT）均包括在内。主要结局是手术部位感染（SSI）。次要结局是手术时间、估计失血量、输血需求、需要将子宫外露、需要额外术后镇痛以及手术视野充分可视化。使用 RevMan 5.3 进行分析。
定性综合和荟萃分析纳入了 6 项 RCT，共 1669 名女性。剖宫产术中使用 O 型环牵开器并不能降低 SSI 的风险，RR 0.76（95%CI 0.34-1.70）。使用 O 型环牵开器也不能减少手术时间、估计失血量、输血需求或额外术后镇痛的需求。使用 O 型环牵开器可减少子宫外露的需求，RR 0.48（95%CI 0.33-0.69），并增加手术视野充分可视化的比率，RR 1.05（95%CI 1.00-1.10）。在计划的亚组分析中，在 BMI<35 的女性中使用 O 型环牵开器可降低 SSI 的发生率，RR 0.34（95%CI 0.12-0.98）。
本综述表明，O 型环牵开器不会降低剖宫产常见可衡量并发症的发生率；SSI、出血量、输血需求和需要额外术后镇痛。在某些亚组中，这些牵开器可能有用，但现有证据并不能证明其在剖宫产中常规使用的合理性。
