宫颈环扎术联合子宫颈托对宫颈机能不全患者临床疗效的meta分析OACSTPCD

Objective:To compare the clinical efficacy of cervical cerclage combined with pessary versus cervical cerclage alone in the prevention of preterm labour in patients with cervical insufficiency by using meta-analysis,and to provide evidence-based medical evidence for clinical diagnosis and treatment.Methods:A computerised search of five databases,inclu-ding CNKI,Wanfang,PubMed,Web of Science,and Cochrane Library,was carried out for all the relevant literature since its inception until 2023-10-1.Two researchers independently per-formed the literature screening,data extraction,and quality assessment based on the inclusion criteria and exclusion criteria.Data were analysed using Review Manager Version 5.4.1 to com-pare the incidence of preterm birth at less than 34 weeks of gestation,preterm birth at less than 37 weeks of gestation,preterm birth at less than 32 weeks of gestation,miscarriage at less than 28 weeks of gestation,and the rates of neonatal NICU admissions,neonatal birth weights,caesar-ean sections,and days of prolonged gestation in the combined group and the cerclage alone group.Results:A total of 1477 potentially relevant articles were retrieved,and after reading the abstracts and deleting duplicates,a total of 5 articles were included in this meta-analysis.Com-paring with the cervical cerclage alone group,the combined use of a pessary and cervical cer-clage group showed no differences in the preterm birth rate at less than 34 weeks of gestation(OR=0.83,95%CI 0.42～1.63,P=0.59),preterm birth rate at less than 37 weeks of gesta-tion(OR=0.90,95%CI 0.55～1.46,P=0.66),preterm birth rate at less than 32 weeks of gestation(OR=0.52,95%CI 0.25～1.07,P=0.08),miscarriage rate at less than 28 weeks gestation(OR=0.53,95%CI 0.21～1.32,P=0.17),neonatal NICU admission rate(OR= 0.77,95%CI 0.44～1.36,P=0.37),neonatal birth weight(MD=37.97,95%CI-263.97～339.92,P=0.81),cesarean section rate(OR=1.22,95%CI 0.50～2.99,P=0.67),pro-longed gestation days(MD=16.09,95%CI-8.41～40.32,P=0.19).However,when the pa-tients with dilated amniotic sac was analysed separately,there was a statistically significant difference between the combined group and the cerclage alone group in terms of prolonging the number of days of gestation(MD=37.39,95%CI 15.98～58.79,P=0.0006),increasing the birth weight of the newborns(MD=722.58,95%CI 145.96～1299.20,P=0.01)and decrea-sing the incidence of preterm labour at less than 32 weeks of gestation(OR=0.20,95%CI 0.06～0.64,P =0.007).Conclusion:In patients with dilated amniotic sacs before cerclage,the combined group significantly prolonged the number of days of gestation,increased neonatal birth weight,and reduced the incidence of spontaneous preterm delivery at less than 32 weeks of ges-tation compared with cerclage alone,but the number of cases in this study is limited,and the findings need to be further examined by a high-quality,large-sample,multicentre,randomised,controlled trial.