Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Lunenfeld-Tanebaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Acta Obstet Gynecol Scand. 2021 Jun;100(6):1010-1018. doi: 10.1111/aogs.14080. Epub 2021 Feb 5.
Barbed sutures are used in cesarean delivery with the intended benefits of better tissue approximation, hemostasis, and strength, as well as reduced operative time. A systematic review and meta-analysis was undertaken to assess the safety and efficacy of the use of barbed suture compared with conventional sutures in cesarean delivery.
MEDLINE, EMBASE, PubMed, Scopus, Cochrane CENTRAL, and three clinical trial registries, were searched from inception to December 2019, without restriction by language or publication year. Randomized controlled trials comparing the use of barbed suture with conventional sutures in closure of any layer (uterine/fascial/skin) during cesarean delivery were included. The safety outcomes included estimated blood loss, pain, mortality, and other morbidity including infection, re-operation or re-admission. Effectiveness outcomes included closure time, need for additional suture and scar integrity. Study selection, data extraction, risk-of-bias, and quality assessment were independently performed by two authors. Primary analysis compared outcomes for all layers of surgical closure, whereas subgroup analysis was performed by individual layer. Pooled mean differences (MD) and risk ratios (RR) with 95% CI were calculated using a random effects model. Level of evidence was assessed using GRADE criteria. PROSPERO registration number: CRD42020168859.
The review included four trials (three comparing uterine closure and one comparing skin closure), at high risk of bias, representing 460 participants. Primary analysis showed no morbidity differences between two groups. The use of barbed suture for uterine closure was associated with shorter incision closure time (MD 110.58 seconds, 95% CI 93.79-127.36 seconds), shorter total surgical time (MD 1.92 minutes, 95% CI 0.03-3.80 minutes), and a reduced need for additional hemostatic sutures (RR 0.39, 95% CI 0.28-0.54), with no difference in estimated blood loss (MD 46.17 mL, 95% CI 13.55 to -105.89 mL) or postoperative morbidity (RR 0.96, 95% CI 0.46-2.01). The level of evidence was deemed to be low to very low, based on inconsistency and imprecision of results.
Barbed sutures may be a suitable alternative to conventional sutures for uterine closure because they reduce uterine repair time, total surgical time, and the need for additional hemostatic sutures, without an increase in blood loss or maternal morbidity.
在剖宫产术中使用带刺缝线的预期益处包括更好的组织接近、止血和强度，以及缩短手术时间。进行了系统评价和荟萃分析，以评估与传统缝线相比，在剖宫产术中使用带刺缝线的安全性和有效性。
从成立到 2019 年 12 月，检索了 MEDLINE、EMBASE、PubMed、Scopus、Cochrane 中央和三个临床试验注册处，没有语言或出版年份的限制。纳入了比较剖宫产术中任何一层（子宫/筋膜/皮肤）使用带刺缝线与传统缝线的随机对照试验。安全性结局包括估计失血量、疼痛、死亡率和其他发病率，包括感染、再次手术或再次入院。有效性结局包括闭合时间、对额外缝线的需求和疤痕完整性。两名作者独立进行了研究选择、数据提取、偏倚风险和质量评估。主要分析比较了所有手术闭合层的结局，而亚组分析则按单个层进行。使用随机效应模型计算了具有 95%置信区间的汇总均数差（MD）和风险比（RR）。使用 GRADE 标准评估证据水平。PROSPERO 注册号：CRD42020168859。
该综述包括四项试验（三项比较子宫闭合，一项比较皮肤闭合），均存在高偏倚风险，代表了 460 名参与者。主要分析显示两组之间无并发症差异。使用带刺缝线进行子宫闭合与切口闭合时间更短（MD 110.58 秒，95%CI 93.79-127.36 秒）、总手术时间更短（MD 1.92 分钟，95%CI 0.03-3.80 分钟）和减少对额外止血缝线的需求（RR 0.39，95%CI 0.28-0.54）有关，估计失血量无差异（MD 46.17 mL，95%CI 13.55 至-105.89 mL）或术后发病率（RR 0.96，95%CI 0.46-2.01）。基于结果的不一致性和不精确性，证据水平被认为是低至非常低。
带刺缝线可能是子宫闭合的传统缝线的合适替代品，因为它们可以减少子宫修复时间、总手术时间和对额外止血缝线的需求，而不会增加失血量或产妇发病率。
