当代产后出血处理方法聚焦子宫压迫缝合术——一项更新的综合性系统评价。
完整摘要 · 中文译文
背景/目的：当保守措施失败时，产后出血（PPH）的手术处理至关重要，但目前各干预措施之间尚无明确的有效性等级排序。鉴于直接比较性研究稀缺，且现有证据在临床和方法学上存在显著异质性，本系统评价旨在针对难治性PPH的子宫压迫缝合术（UCS）管理提供一份更新的、结构化的综合证据。方法：我们检索了2014年1月至2025年12月期间发表的使用与PPH和UCS相关关键词的研究。在排除重复文献并应用纳入和排除标准后，我们筛选出31篇文章。结果：我们将所选文章分为4个部分：单独使用UCS；UCS对比子宫动脉栓塞术（UAE）及对比Bakri球囊填塞术；新型UCS技术；以及关于UCS术后未来生育结局的文章。关于单独使用UCS的证据主要为非对照的观察性病例系列研究，报告的有效率范围为73.9%至100%。新型UCS技术使用可拆除缝线以减少副作用和并发症。尽管关于术后生育能力和月经功能的早期结果看似乐观，但缺乏大型、设计良好的随机研究，因此解读时需谨慎。结论：亚洲三级中心在文献中占主导地位，并报告了较高的子宫保留率，但回顾性设计、小样本、缺乏对照组、对混杂因素校正不足以及技术异质性限制了结论的强度和普适性。剖宫产的主导地位……（注：原文此处“The predominance of cesa”不完整，按要求保留原样，不增删内容） 剖宫产队列进一步限制了其对阴道分娩的普遍适用性。UCS的疗效似乎受到出血严重程度和病例复杂性的强烈影响。
完整摘要 · 英文原文
Background/Objectives: Surgical management of postpartum hemorrhage (PPH) is essential when conservative measures fail, yet no clear hierarchy of effectiveness among interventions exists. Given the scarcity of the direct comparative studies and the substantial clinical and methodological heterogenicity of the available evidence, this systematic review aims to provide an updated and structured synthesis of the UCS for the management of refractory PPH. Methods: We reviewed studies published from January 2014 to December 2025 using keywords related to PPH and UCS. After excluding duplicates and applying the inclusion and exclusion criteria, we selected 31 articles. Results: We grouped the selected articles into 4 sections: UCS alone; UCS versus uterine artery embolization (UAE) and versus Bakri balloon tamponade; newer UCS techniques; and articles on future fertility outcomes after UCS. Evidence on UCS alone was predominantly uncontrolled observational case series, with reported efficacy ranging from 73.9% to 100%. Newer UCS techniques use removable sutures to reduce side effects and complications. Although early results on subsequent fertility and menstrual function appear promising, the lack of large, well-designed randomized studies warrants caution in interpretation. Conclusions: Asian tertiary centers dominate the literature and report high uterine preservation rates, but retrospective design, small samples, lack of controls, inadequate adjustment for confounders, and heterogeneous techniques limit the strength of conclusions and generalizability. The predominance of cesarean section cohort further limits generalizability to vaginal births. UCS efficacy appears strongly influenced by bleeding severity and case complexity.