Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, and University of Florida College of Medicine, Jacksonville, Jacksonville, Florida.
Obstet Gynecol. 2020 Mar;135(3):550-557. doi: 10.1097/AOG.0000000000003673.
To compare the differences in operative time and surgical outcomes between salpingectomy and standard tubal interruption at the time of cesarean delivery.
PubMed, Medline, Google Scholar, Cochrane, and ClinicalTrials.gov were searched from inception until July 2019 for articles reporting outcomes for women undergoing salpingectomy during cesarean delivery compared with women undergoing standard sterilization methods.
Studies were selected if they included the main outcome of operative time or additional outcomes, which included infection, transfusion, readmission, change in hematocrit, and estimated blood loss. The Newcastle-Ottawa Quality Assessment scale or Cochrane Handbook were used to assess quality of cohort and randomized controlled trials (RCTs), respectively. A random-effects model was employed to calculate pooled relative risk or weighted mean difference for each outcome with their 95% CI. Heterogeneity was assessed using the I statistic, and L'Abbé plots were inspected visually to assess for homogeneity.
TABULATION, INTEGRATION, AND RESULTS: We identified 11 studies comprising 320,443 women undergoing total salpingectomy or standard sterilization methods at the time of cesarean delivery. Three RCTs and eight retrospective cohort studies were investigated separately by meta-analysis. When compared with standard sterilization methods, total operative time for patients receiving salpingectomy was significantly longer (6.3 minutes, 95% CI 3.5-9.1, seven studies, 7,303 patients) for cohort studies. With the three RCTs of 163 patients, total operative time was not significantly increased in women receiving salpingectomy (8.1 minutes, 95% CI -4.4 to 20.7). The salpingectomy group did not have an increased risk of wound infection, transfusion, readmission, reoperation, internal organ damage, blood loss, change in hemoglobin, or length of stay when compared with standard sterilization methods.
Salpingectomy at the time of cesarean delivery was associated with a small increase in operative time; however, it was not associated with an increased rate of surgical complications. This option should be considered for patients desiring sterilization during cesarean delivery.
PROSPERO, CRD42019145247.
比较剖宫产时输卵管切除术与标准输卵管阻断术在手术时间和手术结果方面的差异。
从建库到 2019 年 7 月，通过 PubMed、Medline、Google Scholar、Cochrane 和 ClinicalTrials.gov 搜索了报道在剖宫产时行输卵管切除术与行标准绝育方法的妇女的手术时间和其他结局（包括感染、输血、再入院、血细胞比容变化和估计失血量）的文章。如果研究纳入了主要结局（手术时间）或包括感染、输血、再入院、血细胞比容变化和估计失血量等其他结局，则将其纳入研究。分别使用纽卡斯尔-渥太华质量评估量表或 Cochrane 手册评估队列研究和随机对照试验（RCT）的质量。采用随机效应模型计算每个结局的合并相对风险或加权均数差及其 95%CI。采用 I ² 统计量评估异质性，并通过 L'Abbé 图进行直观评估是否存在同质性。
共纳入 11 项研究，共纳入 320443 例行剖宫产时行输卵管切除术或标准绝育方法的妇女。分别对 3 项 RCT 和 8 项回顾性队列研究进行了荟萃分析。与标准绝育方法相比，接受输卵管切除术的患者的总手术时间明显更长（6.3 分钟，95%CI 3.5-9.1，7 项研究，7303 例）（队列研究）。3 项纳入 163 例患者的 RCT 显示，接受输卵管切除术的患者的总手术时间并没有明显增加（8.1 分钟，95%CI -4.4 至 20.7）。与标准绝育方法相比，输卵管切除术组的切口感染、输血、再入院、再次手术、内脏器官损伤、失血量、血红蛋白变化或住院时间无增加。
剖宫产时行输卵管切除术与手术时间略有增加相关，但与手术并发症发生率增加无关。对于希望在剖宫产时行绝育的患者，可考虑这种选择。
PROSPERO，CRD42019145247。
