剖腹产后的局部切除对于胎盘合谱系障碍:系统性审查和元分析
Shinya Matsuzaki1, Brett D Einerson, Loic Sentilhes
1Department of Gynecology, Osaka International Cancer Institute, the Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, and the Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, Japan; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax, Fairfax, Virginia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and the Division of Maternal-Fetal Medicine, the Division of Gynecologic Oncology, and the Norris Comprehensive Cancer Center, University of Southern California, and the Department of Obstetrics and Gynecology, Los Angeles General Medical Center, Los Angeles, California.
与直接切除子宫相比,对胎盘增生谱 (PAS) 的局部切除可能会降低外科病率. 需要进一步的研究来确定PAS患者局部切除的安全性和适用性.
科学领域:
- 产科和妇科 产科和妇科
- 手术瘤学手术瘤学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 胎盘增生谱 (PAS) 在剖腹产期间存在重大风险.
- 管理选择包括立即切除子宫或局部切除.
- 对比结果对于优化患者护理至关重要.
研究的目的:
- 在接受剖腹产分娩的PAS患者中,比较局部切除和即时切除子宫之间的孕产妇和手术结果.
- 通过系统性审查和元分析,综合现有研究的证据.
主要方法:
- 在四个主要数据库 (PubMed,Scopus,Web of Science,Cochrane Central) 进行系统搜索,截至2024年7月31日.
- 纳入标准侧重于比较PAS局部切除与直接切除子宫的研究.
- 使用固定和随机效应模型对11项研究 (2018-2024) 的数据进行元分析.
主要成果:
- 局部切除与显著较低的输血率 (OR 0.47),估计的血液损失 (MD -396 mL),泌尿学并发症 (OR 0.18) 和重症监护室入院 (OR 0.19) 相关.
- 立即切除子宫的组有较高的胎盘穿的流行率 (69.4%对44.3%).
- 包含的研究质量低,有显著的偏差;报告了三起孕产妇死亡事件.
结论:
- 局部切除可能是选择PAS患者的可行选择,以减少手术致病率,尽管研究的局限性.
- 进一步的前性研究对于确定局部切除的指示,安全性,技术和辅助疗法至关重要.
- 目前的证据受到研究质量低下和缺乏治疗意向数据的限制.
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