摘要
目的:探讨腹腔镜和经阴道子宫颈环扎术治疗子宫颈机能不全患者的疗效及安全性。方法:回顾性分析2016年6月至2020年6月因子宫颈机能不全在南京医科大学附属无锡妇幼保健院行子宫颈环扎术的患者资料,共计150例,孕前行腹腔镜子宫颈环扎者61例(A组),其中既往经阴道环扎失败35例;孕期行腹腔镜子宫颈环扎者49例(B组),其中既往经阴道环扎失败25例,孕期行经阴道子宫颈环扎者40例(C组),无既往经阴道环扎失败史。对3组患者的妊娠结局、术中情况、术后并发症进行比较。结果:(1)C组的足月产率、分娩孕周、孕周≥34周分娩率、延长孕周、新生儿存活率均明显低于A组和B组,差异有统计学意义(P<0.05);A组和B组比较,差异无统计学差异(P>0.05)。(2)C组的早产率、难免流产率(35.0%、20.0%)明显高于A组(8.9%、4.9%)和B组(12.2%、4.1%),差异有统计学意义(P<0.05);A组和B组比较,差异无统计学意义(P>0.05)。(3)B组的手术时间(94.0±19.7分钟)明显较A组(44.3±7.4分钟)和C组(25.1±4.7分钟)长,差异有统计学意义(P<0.05)。(4)B组术中出血量(52.0±16.6 ml)明显多于A组(19.2±6.9 ml)、C组(15.5±8.8 ml),差异有统计学意义(P<0.05)。(5)3组均无术中并发症发生,A组和B组术后分别有3例、2例患者孕中期发生难免流产,均在腹腔镜下拆除环扎带后经阴道分娩,C组术后发生并发症8例(20.0%),C组术后并发症发生率高于A组和B组(P<0.05)。结论:腹腔镜下子宫颈环扎术安全、有效,可明显延长妊娠孕周,增加新生儿存活率,孕前和孕期无明显差异,妊娠结局均较经阴道子宫颈环扎好,尤其适用于既往经阴道环扎失败的患者,而孕前腹腔镜子宫颈环扎术手术风险更低,值得临床推广。
Objective:To explore the efficacy and safety of laparoscopic and transvaginal cervical cerclage in the treatment of cervical insufficiency.Methods:A retrospective analysis was made on the data of 150 patients who underwent cervical cerclage in Wuxi Maternal and Child Health Hospital from June 2016 to June 2020 due to cervical insufficiency.All the patients were divided into 3 groups:61 cases(group A)underwent laparoscopic cervical cerclage in the non-pregnant phase,there were 35 patients with previous transvaginal cervical cerclage failure.49 cases(group B)underwent laparoscopic cervical cerclage in the first trimester,there were 25 patients with previous transvaginal cervical cerclage failure.40 cases(group C)underwent vaginal cervical cerclage in second trimester,none of them had failed in previous transvaginal cervical cerclage.Pregnancy outcome,intraoperative and postoperative complications were compared among the three groups.Results:①The full-term delivery rate,delivery gestational age,the rate of childbirth≥34 weeks of gestation,postoperative prolongation of gestational weeks,and neonatal survival rate in group C were significantly lower than those in group A and group B(P<0.05).Comparisons of the above indicators were no statistical differences between group A and group B(P>0.05).②The rate of premature delivery and inevitable abortion in group C(35.0%,20.0%)were significantly higher than that in group A(8.9%,4.9%)and Group B(12.2%,4.1%)(P<0.05),while there were no significant differences between group A and group B(P>0.05).③The operation time of group B(94.0±19.7 min)was significantly longer than that of group A(44.3±7.4 min)and group C(25_1±4_7 min)(P<0.05).④The intrao-perative blood loss of group B(52.0±16.6 ml)was significantly higher than that of group A(19.2±6_9 ml)and group C(15.5±8.8 ml)(P<0.05).⑤There were not intraoperative complications occurred in all three groups.In group A and group B,inevitable abortion was occurred in 3 and 2 patients respectively in the second trimester,w
作者
汪敏
赵绍杰
赵敏
唐艳
WANG Min;ZHAO Shaojie;ZHAO Min(Obstetrics and Gynecology of Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214002,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2022年第2期120-124,共5页
Journal of Practical Obstetrics and Gynecology
基金
国家青年科学基金项目(编号:81100437)
无锡市科技局项目(编号:WX18IIAN031)。
