不同手术方式对剖宫产疤痕憩室治疗效果的Meta分析
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摘要
目的系统评价宫腔镜电切术与经阴式手术治疗剖宫产疤痕憩室的临床效果。方法检索中国生物医学文献数据库、中国知网、万方数据库、PubMed、PHMC、ASP、EBMR、SpringerLink等数据库,查找包含两种手术方式(观察组:宫腔镜电切术;对照组:经阴式手术)治疗剖宫产疤痕憩室的随机对照试验(RCT)相关文献,同时手检纳入文献的参考文献,采用Stata 12.0软件进行Meta分析。结果本研究最终筛选纳入15篇文献,共1 023例患者,其中观察组504例,对照组519例。Meta分析显示,与经阴式手术相比,宫腔镜电切术的手术时间显著缩短[SMD=-2.684,95%CI(-2.881,-2.487),P=0.001],术中出血量显著减少[SMD=-2.300,95%CI(-2.480,-2.119),P=0.000],住院时间显著缩短[SMD=-1.130,95%CI(-1.297,-0.962),P=0.002],但术后月经恢复有效性显著低于经阴式手术[RR=0.779,95%CI(0.732,0.828),P=0.001]。结论与经阴式手术相比,宫腔镜电切术治疗剖宫产疤痕憩室,具有手术时间短、术中出血量少、住院时间短等优势,但术后月经恢复正常的有效性不如经阴式手术。因此,在临床实践中应根据病情需要及现有条件进行综合判断后选择治疗方案。
Objective:To systematically evaluate the efficacy of hysteroscopy electrotomy and transvaginal surgery for previous cesarean scar defect(PCSD)by Mata analysis.Methods:The databases such as SinoMed,CNKI,Wanfang Database,PubMed,ProQuest Health &Medical Complete(PHMC),Academic Search Premier(ASP),EBMR,SpringerLink and other databases were searched to collect the randomized control trials(RCTs)of the hysteroscopy electrotomy and transvaginal surgery for PCSD.At the same time,manual inspection was included for searching the reference literaturee.The Meta-analysis was performed by using the Stata 12.0 software.Results:The total of fifteen RCTs involving 1 023 patients was included.Among them,504 patients were in the hysteroscopy electrotomy group,and 519 patients in the transvaginal surgery group.Meta analysis showed that the operating time was significantly shorter [SMD=-2.684,95%CI(-2.881,-2.487),P=0.001];the intraoperative hemorrhage was significantly less[SMD=-2.300,95%CI(-2.480,-2.119),P=0.000];and hospitalization time was significantly shorter[SMD=-1.130,95%CI(-1.297,-0.962),P=0.002]in the hysteroscopy electrotomy group than that in the transvaginal surgery group.However,the effectiveness of menstrual recovery after surgery was significantly lower in the hysteroscopy electrotomy group[RR=0.779,95%CI(0.732,0.828),P=0.001]compared with transvaginal surgery group.Conclusions:The hysteroscopy electrotomy for previous cesarean scar defect has the advantages of the shorter operation time,less intraoperative blood loss,shorter hospitalization time compared with transvaginal surgery.However,the effectiveness of postoperative menstrual recovery is not as effective as transvaginal surgery.Therefore,in clinical practice,the treatment plan should be selected according to the needs of the disease and the existing conditions
Objective:To systematically evaluate the efficacy of hysteroscopy electrotomy and transvaginal surgery for previous cesarean scar defect(PCSD)by Mata analysis.Methods:The databases such as SinoMed,CNKI,Wanfang Database,PubMed,ProQuest Health &Medical Complete(PHMC),Academic Search Premier(ASP),EBMR,SpringerLink and other databases were searched to collect the randomized control trials(RCTs)of the hysteroscopy electrotomy and transvaginal surgery for PCSD.At the same time,manual inspection was included for searching the reference literaturee.The Meta-analysis was performed by using the Stata 12.0 software.Results:The total of fifteen RCTs involving 1 023 patients was included.Among them,504 patients were in the hysteroscopy electrotomy group,and 519 patients in the transvaginal surgery group.Meta analysis showed that the operating time was significantly shorter [SMD=-2.684,95%CI(-2.881,-2.487),P=0.001];the intraoperative hemorrhage was significantly less[SMD=-2.300,95%CI(-2.480,-2.119),P=0.000];and hospitalization time was significantly shorter[SMD=-1.130,95%CI(-1.297,-0.962),P=0.002]in the hysteroscopy electrotomy group than that in the transvaginal surgery group.However,the effectiveness of menstrual recovery after surgery was significantly lower in the hysteroscopy electrotomy group[RR=0.779,95%CI(0.732,0.828),P=0.001]compared with transvaginal surgery group.Conclusions:The hysteroscopy electrotomy for previous cesarean scar defect has the advantages of the shorter operation time,less intraoperative blood loss,shorter hospitalization time compared with transvaginal surgery.However,the effectiveness of postoperative menstrual recovery is not as effective as transvaginal surgery.Therefore,in clinical practice,the treatment plan should be selected according to the needs of the disease and the existing conditions
引文
[1]王晓.剖宫产子宫切口并发症-切口妊娠、切口憩室、切口愈合和不良180例临床分析[D].河北医科大学,2013:25-52.
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[3]吕冰清,谢熙,刘超斌.176例剖宫产疤痕部位妊娠治疗方式选择及预后分析[J].生殖与避孕,2016,36:240-244.
[4]秦玲.三种手术方式治疗子宫切口憩室的效果分析[D].郑州大学,2014:15-39.
[5]杨晓红,李静文.宫腹腔镜联合手术治疗剖宫产瘢痕憩室临床分析[J].中华全科医学,2015,13:973-975.
[6]何惠,胡华敏,沈奇.剖宫产宫壁疤痕缺损不同手术方式治疗效果比较[J].中华全科医学,2017,15:82-84.
[7]郑敏慧.不同方法治疗有症状子宫疤痕憩室的临床效果观察[J].中国医学工程,2017,11:56-57.
[8]刘文辉.宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的临床效果对比分析[J].中国现代药物应用,2016,10:87-88.
[9]王莹.宫腔镜技术在剖宫产子宫切口瘢痕缺陷治疗中的应用价值[J].中国妇幼保健,2016,31:3166-3168.
[10]陈静.宫腔镜在子宫切口憩室治疗中的效果分析[J].中国继续医学教育,2015,7:53-54.
[11]熊夏思.阴式手术与宫腔镜手术治疗剖宫产术后子宫切口憩室的疗效比较[J].实用临床医学,2015,16:49-51.
[12]郭玲,黄华仪.剖腹产子宫疤痕缺损的临床诊断和治疗[J].中医临床研究,2016,8:111-113.
[13]李莹.宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室患者的疗效比较[J].中国药物经济学,2016,11:128-130.
[14]梁凤霞,黄玉玲.两种手术方式在子宫瘢痕缺损治疗中的价值[J].中国计划生育和妇产科,2014,6:40-42.
[15]丁勇利,彭秀红.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术在子宫瘢痕憩室治疗中的作用[J].中国妇幼卫生杂志,2013,4:20-21,23.
[16]李丹.不同手术方案治疗剖宫产术后子宫切口憩室的效果比较[J].临床合理用药杂志,2017,10:132-133.
[17]刘小媚,袁秀英,刘燕燕.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术在子宫瘢痕憩室治疗中的作用探讨[J].中国医药指南,2014,12:164-165.
[18]冯晓冰,陈建国.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术治疗子宫瘢痕憩室的效果比较[J].广西医科大学学报,2016,33:521-523.
[19]Luo L,Niu G,Wang Q,et al.Vaginal repair of cesarean section scar diverticula[J].J Minim Invasive Gynecol,2012,19,454-458.
[20]刘霞,郭彩霞,汤艳红.宫腔镜在治疗剖宫产疤痕处妊娠的临床价值[J].现代妇产科进展,2012,21:815-816.
[21]陈林霞.剖宫产术后子宫瘢痕妊娠诊断与治疗[J].中外医疗,2013,32:32-33.
[22]陈寸.基于B超的检查对预测妊娠疤痕子宫破裂的临床意义[J].生殖医学杂志,2017,26:266-268.
[2]陈丽梅,隋龙.剖宫产切口憩室及其相关临床问题[J].国际妇产科学杂志,2015,42:335-338.
[3]吕冰清,谢熙,刘超斌.176例剖宫产疤痕部位妊娠治疗方式选择及预后分析[J].生殖与避孕,2016,36:240-244.
[4]秦玲.三种手术方式治疗子宫切口憩室的效果分析[D].郑州大学,2014:15-39.
[5]杨晓红,李静文.宫腹腔镜联合手术治疗剖宫产瘢痕憩室临床分析[J].中华全科医学,2015,13:973-975.
[6]何惠,胡华敏,沈奇.剖宫产宫壁疤痕缺损不同手术方式治疗效果比较[J].中华全科医学,2017,15:82-84.
[7]郑敏慧.不同方法治疗有症状子宫疤痕憩室的临床效果观察[J].中国医学工程,2017,11:56-57.
[8]刘文辉.宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的临床效果对比分析[J].中国现代药物应用,2016,10:87-88.
[9]王莹.宫腔镜技术在剖宫产子宫切口瘢痕缺陷治疗中的应用价值[J].中国妇幼保健,2016,31:3166-3168.
[10]陈静.宫腔镜在子宫切口憩室治疗中的效果分析[J].中国继续医学教育,2015,7:53-54.
[11]熊夏思.阴式手术与宫腔镜手术治疗剖宫产术后子宫切口憩室的疗效比较[J].实用临床医学,2015,16:49-51.
[12]郭玲,黄华仪.剖腹产子宫疤痕缺损的临床诊断和治疗[J].中医临床研究,2016,8:111-113.
[13]李莹.宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室患者的疗效比较[J].中国药物经济学,2016,11:128-130.
[14]梁凤霞,黄玉玲.两种手术方式在子宫瘢痕缺损治疗中的价值[J].中国计划生育和妇产科,2014,6:40-42.
[15]丁勇利,彭秀红.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术在子宫瘢痕憩室治疗中的作用[J].中国妇幼卫生杂志,2013,4:20-21,23.
[16]李丹.不同手术方案治疗剖宫产术后子宫切口憩室的效果比较[J].临床合理用药杂志,2017,10:132-133.
[17]刘小媚,袁秀英,刘燕燕.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术在子宫瘢痕憩室治疗中的作用探讨[J].中国医药指南,2014,12:164-165.
[18]冯晓冰,陈建国.宫腔镜电切及经阴道子宫瘢痕憩室切除缝合术治疗子宫瘢痕憩室的效果比较[J].广西医科大学学报,2016,33:521-523.
[19]Luo L,Niu G,Wang Q,et al.Vaginal repair of cesarean section scar diverticula[J].J Minim Invasive Gynecol,2012,19,454-458.
[20]刘霞,郭彩霞,汤艳红.宫腔镜在治疗剖宫产疤痕处妊娠的临床价值[J].现代妇产科进展,2012,21:815-816.
[21]陈林霞.剖宫产术后子宫瘢痕妊娠诊断与治疗[J].中外医疗,2013,32:32-33.
[22]陈寸.基于B超的检查对预测妊娠疤痕子宫破裂的临床意义[J].生殖医学杂志,2017,26:266-268.