Qayum Kaif, Kar Irfan, Sofi Junaid, Panneerselvam Hari
General Surgery, Wye Valley NHS Foundation Trust, Hereford, GBR.
General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, IND.
Cureus. 2021 Sep 30;13(9):e18405. doi: 10.7759/cureus.18405. eCollection 2021 Sep.
Cesarean section (CS) delivery is a common procedure, and its incidence is increasing globally. To compare single-layer (SL) with double-layer (DL) uterine closure techniques after cesarean section in terms of ultrasonographic findings and rate of CS complications. PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4). Eighteen RCTs were included in our study. Pooled results favored DL uterine closure in terms of residual myometrial thickness (MD = -1.15; 95% CI -1.69, -0.60; P < 0.0001) and dysmenorrhea (RR = 1.36; 95% CI 1.02, 1.81; P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25; 95% CI -3.29, -1.21; P < 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88; 95% CI 0.63, 5.62; P = 0.26), healing ratio (MD = -5.00; 95% CI -12.40, 2.39; P = 0.18), maternal infectious morbidity (RR = 0.94; 95% CI 0.66, 1.34; P = 0.72), hospital stay (MD = -0.12; 95% CI -0.30, 0.06; P = 0.18), and readmission rate (RR = 0.95; 95% CI 0.64, 1.40; P = 0.78). Double-layer uterine closure shows more residual myometrial thickness and lower incidence of dysmenorrhea than single-layer uterine closure of cesarean section scar. But single-layer closure has the advantage of the shorter operation time. Both methods have comparable blood loss amount, healing ratio, hospital stay duration, maternal infection risk, readmission rate, and uterine dehiscence or rupture risk.
剖宫产是一种常见的手术，其发生率在全球范围内呈上升趋势。比较剖宫产术后单层与双层子宫缝合技术的超声检查结果及剖宫产并发症发生率。检索了PubMed、Scopus、Web of Science和Cochrane图书馆，查找相关的随机临床试验（RCT）。对检索到的文章进行筛选，并将相关研究纳入荟萃分析。连续数据合并为平均差（MD）及95%置信区间（CI），二分数据合并为相对风险（RR）及95%CI。使用RevMan软件（5.4版）进行分析。本研究纳入了18项RCT。汇总结果显示，双层子宫缝合在残余肌层厚度（MD = -1.15；95%CI -1.69，-0.60；P < 0.0001）和痛经方面（RR = 1.36；95%CI 1.02，1.81；P = 0.04）更具优势，而单层缝合的手术时间比双层缝合短（MD = -2.25；95%CI -3.29，-1.21；P < 0.00001）。两种技术在子宫裂开或破裂（RR = 1.88；95%CI 0.63，5.62；P = 0.26）、愈合率（MD = -5.00；95%CI -12.40，2.39；P = 0.18）、产妇感染发病率（RR = 0.94；95%CI 0.66，1.34；P = 0.72）、住院时间（MD = -0.12；95%CI -0.30，0.06；P = 0.18）和再入院率（RR = 0.95；95%CI 0.64，1.40；P = 0.78）方面结果相似。与剖宫产瘢痕单层子宫缝合相比，双层子宫缝合显示出更多的残余肌层厚度和更低的痛经发生率。但单层缝合具有手术时间短的优势。两种方法在失血量、愈合率、住院时间、产妇感染风险、再入院率以及子宫裂开或破裂风险方面具有可比性。
