摘要
目的 探讨子宫颈环扎术治疗子宫颈机能不全的临床效果,分析影响预后的相关因素,明确不同手术方式、时机的优劣性。方法 回顾性分析2015年3月至2021年3月于厦门大学附属第一医院产科治疗的172例子宫颈机能不全妇女接受子宫颈环扎术后妊娠结局。其中23例于孕前行腹腔镜子宫颈环扎术为A组,48例于孕期行经阴道预防性子宫颈环扎术者为B组,63例于产检时彩超发现子宫颈缩短<25mm、宫口未见明显扩张时行治疗性子宫颈环扎术为C组,38例于发现子宫颈进行性扩张>10mm行紧急子宫颈环扎术分为D组。经过χ^(2)检验及t检验分析4组一般情况及妊娠结局的差异。对C组病例进行单因素分析,明确影响妊娠结局的高危因素。结果 4组间足月产率、新生儿体重差异均有统计学意义(均P<0.001),其中A组足月产率87.0%、新生儿体重最高。对C组病例进行单因素分析提示子宫颈环扎手术时剩余子宫颈长度是影响C组预后的危险因素,术前子宫颈长度>15mm足月产率高于子宫颈长度≤15mm(70.4%vs. 36.1%,P=0.011),logistic多因素回归分析提示宫口扩张≥30mm、不良孕史、经产妇为影响治疗性子宫颈环扎足月产率的独立危险因素。结论 腹腔镜子宫颈环扎术预后要优于经阴道子宫颈环扎术,而经阴道子宫颈环扎术中,预防性子宫颈环扎效果要明显好于紧急性子宫颈环扎。而对于行紧急子宫颈环扎术的孕妇在子宫颈口扩张前适时实施手术,手术效果要远好于子宫颈明显扩张的孕妇。
Objective To investigate the clinical effect of cervical cerclage in the treatment of cervical incompetence,analyze the related factors affecting the prognosis,and clarify the advantages and disadvantages of different surgical methods and timing.Methods A retrospective analysis was performed concerning the pregnancy outcomes of 172 cases of cervical incompetence treated by cervical cerclage in the Department of Obstetrics,the First Affiliated Hospital of Xiamen University from March 2015 to March 2021.Among them,23 cases who were treated with laparoscopic cerclage before pregnancy were classified as group A,48 cases with vaginal preventive cerclage during pregnancy as group B,63cases who were treated with therapeutic cerclage when the cervix was shorter than 25mm and the cervix was not obviously dilated by color Doppler ultrasound during prenatal examination were classified as group C,and 38 cases who were treated with emergancy cerclage when progressive dilatation of the cervix was more than 10mm were divided into group D.The differences in general conditions and pregnancy outcomes among the four groups were analyzed by chisquare test and t-test.Univariate analysis was performed for group C cases to identify the high-risk factors affecting pregnancy outcome.Results There were significant differences in term birth rate(P<0.001) and live birth weight(P<0.001) among the four groups,and the term birth rate of group A was 87.0% and the live birth weight was the highest.Univariate analysis of patients in group C showed that residual cervical length during cervical cerclage operation was a risk factor affecting the prognosis of group C.The term birth rate of cervical length> 15mm before operation was higher than that of cervical length≤ 15mm(70.4% vs.36.10%,P=0.011).Logistic multivariate regression analysis showed that uterine dilatation≥30mm,adverse pregnancy history and multiparous women were independent risk factors for term birth rate of therapeutic cervical cerclage.Conclusions The prognosis of laparoscopic cervical cerclage is better than that of transvaginal cervical cerclage,and in transvaginal cervical cerclage,the effect of preventive cervical cerclage is significantly better than that of emergency cervical cerclage.For patients who under emergency cervical cerclage,the operation should be performed in a timely manner before cervical dilatation,and the surgical effect is much better than that of patients with obvious cervical dilatation.
作者
陈国庆
李晓东
周颖
姜金娜
林雅真
吴芹
CHEN Guo-qing;LI Xiao-dong;ZHOU Ying;JIANG Jin-na;LIN Ya-zhen;WU Qin(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Xiamen University,Fujian Branch of National Clinical Medical Research Center for Obstetrics and Gynecology,Fujian Clinical Medical Research Center for Reproductive Health,Xiamen 361001,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2023年第2期221-225,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
福建省自然科学基金(2021J05298)。
作者简介
通讯作者:李晓东,电子信箱:lixiaodong5112@126.com。
