{"title":"腹膜外与经腹剖宫产的比较分析:随机对照试验和系统评价的荟萃分析。","authors":"Mengmeng Jia, Guangquan Ji, Ruifang Wang, Zhen Yan, Wei Niu, Jian Chen, Juanjuan Yu","doi":"10.1186/s12893-025-02981-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to systematically evaluate the efficacy of Extraperitoneal Cesarean Section (ECS) compared to Transabdominal Cesarean Section (TCS) in pregnant women, and to assess the differences in treatment outcomes between the two surgical approaches.</p><p><strong>Approach and techniques: </strong>We conducted an extensive literature search, pulling up the most recent findings from reputable sources like the Cochrane Library, PubMed, EMBASE, Google Scholar, and Web of Science, all the way up to October 2024. Our meta-analysis comprised seven randomized controlled trials. We followed a fixed-effects model for results with less heterogeneity and a random-effects model for those with more. We utilized Stata 18 to conduct data analysis. For continuous data, we computed weighted mean differences (WMD). For categorical data, we calculated odds ratios (OR). We also included 95% confidence intervals (CI) with all of our results. We also used the Cochrane Risk of Bias tool to check all of the randomized controlled trials (RCTs) for bias.</p><p><strong>Results: </strong>This meta-analysis did not find any statistically significant differences between the two groups when it came to baseline factors such as Body Mass Index (BMI), gestational week, and history of cesarean section. Statistical analysis revealed no significant differences in surgical outcomes (i.e., time to delivery(WMD 2.25, 95% CI -0.29 to 4.79, p = 0.083), time to operation (WMD 3.11, 95% CI -2.96 to 9.18, p = 0.316), neonatal weight (WMD -62.25, 95% CI -152.37 to 27.87, p = 0.176), 1-min Apgar score (WMD 0.03, 95% CI -0.39 to 0.45, p = 0.897), 5-min Apgar score (WMD 0.09, 95% CI -0.07 to 0.24, p = 0.296), blood loss (WMD 36.41, 95% CI -21.51 to 94.32, p = 0.218), etc.) between the TCS and ECS groups. However, the ECS group had a significantly shorter hospital stay (WMD -0.51, 95% CI -0.89 to -0.13, p=0.009) and less reduction in hemoglobin level (WMD -0.23, 95% CI -0.39 to -0.07, p=0.004) compared to TCS.</p><p><strong>Conclusion: </strong>To sum up, this meta-analysis shows that ECS may help with postoperative hemoglobin level changes and shortening hospital stays. ECS may improve recovery metrics without adversely affecting maternal or neonatal outcomes. This analysis provides valuable insights that can guide clinical decision-making, even though there was no statistically significant difference between the two surgical approaches in terms of delivery time, operative time, neonatal weight, Apgar scores, or blood loss.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"266"},"PeriodicalIF":1.6000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative analysis of extraperitoneal versus transabdominal cesarean sections: a meta-analysis of randomized controlled trials and systematic review.\",\"authors\":\"Mengmeng Jia, Guangquan Ji, Ruifang Wang, Zhen Yan, Wei Niu, Jian Chen, Juanjuan Yu\",\"doi\":\"10.1186/s12893-025-02981-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The objective of this study is to systematically evaluate the efficacy of Extraperitoneal Cesarean Section (ECS) compared to Transabdominal Cesarean Section (TCS) in pregnant women, and to assess the differences in treatment outcomes between the two surgical approaches.</p><p><strong>Approach and techniques: </strong>We conducted an extensive literature search, pulling up the most recent findings from reputable sources like the Cochrane Library, PubMed, EMBASE, Google Scholar, and Web of Science, all the way up to October 2024. Our meta-analysis comprised seven randomized controlled trials. We followed a fixed-effects model for results with less heterogeneity and a random-effects model for those with more. We utilized Stata 18 to conduct data analysis. For continuous data, we computed weighted mean differences (WMD). For categorical data, we calculated odds ratios (OR). We also included 95% confidence intervals (CI) with all of our results. We also used the Cochrane Risk of Bias tool to check all of the randomized controlled trials (RCTs) for bias.</p><p><strong>Results: </strong>This meta-analysis did not find any statistically significant differences between the two groups when it came to baseline factors such as Body Mass Index (BMI), gestational week, and history of cesarean section. Statistical analysis revealed no significant differences in surgical outcomes (i.e., time to delivery(WMD 2.25, 95% CI -0.29 to 4.79, p = 0.083), time to operation (WMD 3.11, 95% CI -2.96 to 9.18, p = 0.316), neonatal weight (WMD -62.25, 95% CI -152.37 to 27.87, p = 0.176), 1-min Apgar score (WMD 0.03, 95% CI -0.39 to 0.45, p = 0.897), 5-min Apgar score (WMD 0.09, 95% CI -0.07 to 0.24, p = 0.296), blood loss (WMD 36.41, 95% CI -21.51 to 94.32, p = 0.218), etc.) between the TCS and ECS groups. However, the ECS group had a significantly shorter hospital stay (WMD -0.51, 95% CI -0.89 to -0.13, p=0.009) and less reduction in hemoglobin level (WMD -0.23, 95% CI -0.39 to -0.07, p=0.004) compared to TCS.</p><p><strong>Conclusion: </strong>To sum up, this meta-analysis shows that ECS may help with postoperative hemoglobin level changes and shortening hospital stays. ECS may improve recovery metrics without adversely affecting maternal or neonatal outcomes. This analysis provides valuable insights that can guide clinical decision-making, even though there was no statistically significant difference between the two surgical approaches in terms of delivery time, operative time, neonatal weight, Apgar scores, or blood loss.</p>\",\"PeriodicalId\":49229,\"journal\":{\"name\":\"BMC Surgery\",\"volume\":\"25 1\",\"pages\":\"266\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12893-025-02981-y\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12893-025-02981-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究的目的是系统评价腹膜外剖宫产术(ECS)与经腹剖宫产术(TCS)在孕妇中的疗效,并评价两种手术方式治疗效果的差异。方法和技术:我们进行了广泛的文献检索,从Cochrane Library、PubMed、EMBASE、谷歌Scholar和Web of Science等知名来源中提取最新发现,一直到2024年10月。我们的荟萃分析包括七个随机对照试验。对于异质性较小的结果,我们采用固定效应模型,而对于异质性较大的结果,我们采用随机效应模型。我们使用Stata 18进行数据分析。对于连续数据,我们计算加权平均差(WMD)。对于分类数据,我们计算优势比(OR)。我们还在所有结果中纳入了95%置信区间(CI)。我们还使用Cochrane偏倚风险工具检查所有随机对照试验(rct)的偏倚。结果:该荟萃分析未发现两组在体重指数(BMI)、妊娠周和剖宫产史等基线因素方面有统计学上的显著差异。统计分析显示手术的结果没有显著差异(例如,交付时间(大规模杀伤性武器2.25,95%可信区间-0.29到4.79,p = 0.083),时间操作(大规模杀伤性武器3.11,95%可信区间-2.96到9.18,p = 0.316),新生儿体重(大规模杀伤性武器-62.25,95%可信区间-152.37到27.87,p = 0.176),(阿普加分数(大规模杀伤性武器0.03,95%可信区间-0.39到0.45,p = 0.897), 5分钟阿普加分数(大规模杀伤性武器0.09,95%可信区间-0.07到0.24,p = 0.296),失血(大规模杀伤性武器36.41,95%可信区间-21.51到94.32,p = 0.218),等)之间的TCS和ECS组。然而,与TCS相比,ECS组的住院时间明显缩短(WMD -0.51, 95% CI -0.89至-0.13,p=0.009),血红蛋白水平降低较少(WMD -0.23, 95% CI -0.39至-0.07,p=0.004)。结论:综上所述,本荟萃分析显示ECS可能有助于术后血红蛋白水平的变化和缩短住院时间。ECS可以改善恢复指标,而不会对产妇或新生儿的预后产生不利影响。尽管两种手术方式在分娩时间、手术时间、新生儿体重、Apgar评分或出血量方面没有统计学上的显著差异,但该分析为指导临床决策提供了有价值的见解。
Comparative analysis of extraperitoneal versus transabdominal cesarean sections: a meta-analysis of randomized controlled trials and systematic review.
Objective: The objective of this study is to systematically evaluate the efficacy of Extraperitoneal Cesarean Section (ECS) compared to Transabdominal Cesarean Section (TCS) in pregnant women, and to assess the differences in treatment outcomes between the two surgical approaches.
Approach and techniques: We conducted an extensive literature search, pulling up the most recent findings from reputable sources like the Cochrane Library, PubMed, EMBASE, Google Scholar, and Web of Science, all the way up to October 2024. Our meta-analysis comprised seven randomized controlled trials. We followed a fixed-effects model for results with less heterogeneity and a random-effects model for those with more. We utilized Stata 18 to conduct data analysis. For continuous data, we computed weighted mean differences (WMD). For categorical data, we calculated odds ratios (OR). We also included 95% confidence intervals (CI) with all of our results. We also used the Cochrane Risk of Bias tool to check all of the randomized controlled trials (RCTs) for bias.
Results: This meta-analysis did not find any statistically significant differences between the two groups when it came to baseline factors such as Body Mass Index (BMI), gestational week, and history of cesarean section. Statistical analysis revealed no significant differences in surgical outcomes (i.e., time to delivery(WMD 2.25, 95% CI -0.29 to 4.79, p = 0.083), time to operation (WMD 3.11, 95% CI -2.96 to 9.18, p = 0.316), neonatal weight (WMD -62.25, 95% CI -152.37 to 27.87, p = 0.176), 1-min Apgar score (WMD 0.03, 95% CI -0.39 to 0.45, p = 0.897), 5-min Apgar score (WMD 0.09, 95% CI -0.07 to 0.24, p = 0.296), blood loss (WMD 36.41, 95% CI -21.51 to 94.32, p = 0.218), etc.) between the TCS and ECS groups. However, the ECS group had a significantly shorter hospital stay (WMD -0.51, 95% CI -0.89 to -0.13, p=0.009) and less reduction in hemoglobin level (WMD -0.23, 95% CI -0.39 to -0.07, p=0.004) compared to TCS.
Conclusion: To sum up, this meta-analysis shows that ECS may help with postoperative hemoglobin level changes and shortening hospital stays. ECS may improve recovery metrics without adversely affecting maternal or neonatal outcomes. This analysis provides valuable insights that can guide clinical decision-making, even though there was no statistically significant difference between the two surgical approaches in terms of delivery time, operative time, neonatal weight, Apgar scores, or blood loss.