Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel.
J Minim Invasive Gynecol. 2022 Jul;29(7):832-839. doi: 10.1016/j.jmig.2022.05.001. Epub 2022 May 7.
OBJECTIVE: To compare perioperative outcomes between knotless barbed sutures (KBSs) and conventional smooth sutures for uterine incision closure at cesarean section. DATA SOURCES: MEDLINE, EMBASE, Web of Sciences, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from the inception of the study to March 2021 without language restriction. The search terms were as follows: ["Stratafix" OR "Quill" OR "V-Loc" OR "Barbs" OR "barbed"] AND ["Cesarean" OR "Caesarean"] AND ["Suturing" OR "Suture" OR "Closure" OR "Repair"]. Moreover, these terms were combined to complete the search. METHODS OF STUDY SELECTION: Retrospective and randomized peer-reviewed studies comparing the use of KBSs and conventional sutures for uterine incision closure at cesarean section were included. The studies' quality was assessed by the Cochrane risk-of-bias tool. The primary outcome was the time of uterine incision closure in seconds. The secondary outcomes included total operating time (minutes), use of additional hemostatic sutures, rates of blood transfusion, and postoperative complications. TABULATION, INTEGRATION, AND RESULTS: Of 20 reports identified, 4 representing 3332 women (1473 with KBSs and 1859 with conventional sutures) were eligible. All studies were judged to be at low risk of bias. The uterine incision closure time was significantly lower in the KBS group (mean difference, -110.58; 95% confidence interval [CI], -127.37 to -93.79; p = .001). Furthermore, the rate of use of additional hemostatic sutures was significantly lower in the KBS group (odds ratio, 0.14; 95% CI, 0.07-0.26; p = .001). Total operative time, rates of blood transfusion, febrile morbidity, and length of postoperative stay were comparable. The incidence of postoperative ileus was significantly lower in the KBS group (odds ratio, 0.31; 95% CI, 0.11-0.89; p = .029). CONCLUSION: The use of KBSs for uterine incision closure was associated with decreased hysterotomy closure time and less frequent need for the placement of additional hemostatic sutures. Other perioperative outcomes were not affected, although the risk of postoperative ileus was reduced.
目的：比较剖宫产子宫切口缝合中使用无结缝合线（KBS）与传统光滑缝线的围手术期结局。
资料来源：从研究开始到 2021 年 3 月，在 MEDLINE、EMBASE、Web of Sciences、Scopus、Cochrane 图书馆和 ClinicalTrials.gov 上搜索，无语言限制。检索词如下：["Stratafix" 或 "Quill" 或 "V-Loc" 或 "Barbs" 或 "barbed"] 和 ["Cesarean" 或 "Caesarean"] 和 ["Suturing" 或 "Suture" 或 "Closure" 或 "Repair"]。此外，这些术语被组合在一起以完成搜索。
研究选择方法：纳入了比较剖宫产子宫切口缝合中使用 KBS 与传统缝线的回顾性和随机同行评审研究。使用 Cochrane 偏倚风险工具评估研究质量。主要结局是子宫切口缝合的时间（以秒为单位）。次要结局包括总手术时间（分钟）、额外止血缝线的使用、输血率和术后并发症。
列表、综合和结果：在 20 份报告中，有 4 份报告（代表 3332 名女性，1473 名使用 KBS，1859 名使用传统缝线）符合条件。所有研究均被判断为低偏倚风险。KBS 组的子宫切口缝合时间明显更短（平均差异，-110.58；95%置信区间[CI]，-127.37 至-93.79；p=0.001）。此外，KBS 组额外止血缝线使用率明显更低（比值比，0.14；95%CI，0.07-0.26；p=0.001）。总手术时间、输血率、发热发病率和术后住院时间无差异。术后肠梗阻的发生率明显更低（比值比，0.31；95%CI，0.11-0.89；p=0.029）。
结论：在剖宫产子宫切口缝合中使用 KBS 可缩短子宫切开闭合时间，并减少额外止血缝线的使用。虽然术后肠梗阻的风险降低，但其他围手术期结局无影响。
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