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剖宫产与阴道顺产对盆底功能影响的Meta分析

Meta-analysis of the influence of cesarean section and vaginal delivery on pelvic floor function

  • 摘要: 目的 系统评价剖宫产与阴道顺产两种不同分娩方式对盆底功能的影响。方法 全面检索2015年1月—2019年4月期间维普期刊网、万方数据库、中国期刊全文数据库、Pub Med数据库、Library of Congress数据库、Web of Science数据库中公开发表的关于剖宫产与阴道顺产对盆底功能影响的相关文献。提取数据后,采用Stata 15.0软件进行Meta分析。结果 共纳入20个符合要求的文献,7 081例产妇,其中剖宫产2 965例,阴道顺产4 116例。Meta分析结果显示:两种不同分娩方式在阴道前壁脱垂率、阴道后壁脱垂率、子宫脱垂率、尿失禁发生率、盆腔器官脱垂发生率、浅层肌力受损、深层肌力受损等方面比较,差异均有统计学意义(P<0.05)。结论 剖宫产对盆底功能的影响较阴道顺产小,在一定程度上降低了盆底肌肉损伤及盆底功能障碍性疾病(pelvic floor disease,PFD)的发生率,但剖宫产不能完全避免PFD的发生,不能作为选择剖宫产的依据。

     

    Abstract: Objective To systematically evaluate the influence of cesarean section and vaginal delivery on pelvic floor function. Methods A comprehensive search of scientific literature focusing on the influence of cesarean section and vaginal delivery on pelvic floor function published from January 2015 to April 2019 was conducted through database of VIP Journal Network,Wanfang,China Journal Full-text,Pub Med,Library of Congress,and Web of Science. Meta-analysis was conducted with stata 15. 0 software. Results A total of 7 081 maternal women were included in 20 qualified studies,including 2 965 cases of cesarean section and 4 116 cases of vaginal delivery. Meta-analysis results showed that the rate of vaginal anterior wall prolapse,vaginal posterior wall prolapse,uterine prolapse,urinary incontinence,pelvic organ prolapsed,impaired muscle strength,and impaired deep muscle strength were different in various modes of delivery. The difference was statistically significant(P< 0. 05). Conclusion The effect of cesarean section on pelvic floor function is less than that of vaginal delivery,which reduces the incidence of pelvic floor muscle injury and pelvic floor disease(PFD) to a certain extent. However,cesarean section can not be used as the principle to choose cesarean section because it is not able to avoid the occurrence of PFD completely.

     

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