不同剖宫产术式对于再次剖宫产结局影响的Meta分析

Meta-Analysis of the Influence of Different Cesarean Section Methods on the Outcome of Cesarean Section Again

摘要: 目的：比较不同剖宫产术式对于再次剖宫产孕产妇及新生儿临床结局的影响。方法：系统检索知网、万方、维普、Sinomed等数据库，时间截止至2023年9月1日随机对照试验研究。主要结局指标：腹腔粘连(无)、盆腔粘连(无)、瘢痕(轻微)；次要结局指标：产后大出血、切口感染、新生儿窒息。使用Review Manager (v.5.4)软件进行Meta分析。结果：腹腔粘连(无)经分析后(RR = 0.56, 95%CI [0.49, 0.65], P < 0.01)显示，两组间差异有统计学意义。盆腔粘连(无)经分析后(RR = 1.25, 95%CI [0.69, 2.28], P = 0.46)显示，两组间差异无统计学意义。瘢痕(轻微)经分析后(RR = 0.43, 95%CI [0.27, 0.68], P < 0.01)显示，两组间差异有统计学意义。产后大出血经分析后(RR = 0.71, 95%CI [0.53, 0.95], P = 0.02)显示，两组间差异有统计学意义。切口感染经分析后(RR = 0.37, 95%CI [0.20, 0.68], P < 0.01)显示，两组间差异有统计学意义。盆腔粘连(无)与新生儿窒息经分析后差异无统计学意义。结论：对于再次剖宫产的孕产妇，腹壁纵切式能够降低腹腔粘连和瘢痕的发生率，而横切式能够降低术后大出血以及切口感染的发生率；对于腹壁切口术式的选择应当充分考虑孕产妇包括二次妊娠的意愿，提供个体化管理模式；同时，为未来大型、多中心随机对照试验以及临床指南的实施与构建提供更多的科学参考依据。

Abstract: Objective: To compare the effects of different cesarean section methods on the clinical outcomes of pregnant women and newborns undergoing cesarean section again. Methods: The databases of China National Knowledge Infrastructure (CNKI), Wanfang, VIP and Sinomed were searched systematically up to September 1, 2023 for randomized controlled trial studies. Main outcome measures are: abdominal adhesion (none), pelvic adhesion (none) and scar (slight); secondary outcome measures are: postpartum hemorrhage, incision infection and neonatal asphyxia. Review Manager (v.5.4) software is used for Meta-analysis. Results: After analysis of abdominal adhesions (none) (RR = 0.56, 95%CI [0.49, 0.65], P < 0.01), there was a significant difference between the two groups. After analysis of pelvic adhesion (none) (RR = 1.25, 95%CI [0.69, 2.28], P = 0.46), there was no significant difference between the two groups. After analysis of scar (slight) (RR = 0.43, 95%CI [0.27, 0.68], P < 0.01), the difference between the two groups was statistically significant. After analysis of postpartum hemorrhage (RR = 0.71, 95%CI [0.53, 0.95], P = 0.02), the difference between the two groups was statistically significant. After analysis of incision infection (RR = 0.37, 95%CI [0.20, 0.68], P < 0.01), the difference between the two groups was statistically significant. There was no significant difference between pelvic adhesion (none) and neonatal asphyxia after analysis. Conclusion: For pregnant women undergoing cesarean section again, longitudinal abdominal wall cutting can reduce the incidence of abdominal adhesion and scar, while transverse abdominal wall cutting can reduce the incidence of postoperative hemorrhage and incision infection. The choice of abdominal incision should fully consider the wishes of pregnant women, including the second pregnancy, and provide individualized management mode. At the same time, it will provide more scientific reference for the implementation and construction of large-scale and multi-center randomized controlled trials and clinical guidelines in the future.