紧急宫颈环扎术治疗妊娠中期宫颈机能不全41例临床分析

Emergency cervical cerclge for cervical insufficiency: 41 cases of clinical analysis

目的 探讨影响紧急宫颈环扎术成功率的因素,评价紧急宫颈环扎术对治疗妊娠中期宫颈机能不全的意义。方法 回顾性分析笔者所在医院2009年9月～2010年5月施行了紧急宫颈环扎术的41例宫颈机能不全患者的临床资料,其中18例为环扎术前宫口≥2cm者,41例环扎术前均无感染迹象。延长孕周至妊娠32周以后分娩并获得活产新生儿为良好妊娠结局。结果 41例患者手术过程顺利,22例患者获得良好结局,其中缝扎术前宫口≥2cm者仅2例结局良好,共有14例孕周达到了37周。妊娠不良结局者中有15例(79%)查出绒毛膜羊膜炎。羊膜囊突出、宫口扩张、感染与不良妊娠结局相关。结论 紧急宫颈环扎术能延长孕周,有效改善妊娠结局,是治疗妊娠期宫颈机能不全的有效措施,但环扎术前宫口≥2cm者效果不佳。

Objective To discuss predictors of success of emergency cervical cerclage for cervical insufficiency. Methods This was a retrospective cohort study of 41 patients underwent emergency cervical cerclge from September 2009 to May 2010 in Foshan Maternal and Children Hospital,including 18 patients with external os 〉2 cm,and the evidence of infection was abcent before cerclage. A＂good outcome＇was defined as delivery after 32 weeks and healthy at discharge. Results Forty emergency cerclages were performed successfully. 20 patients had a ＂good outcome＂ ,including 2 patients with cervical dilattion 〉2 cm. 14 pregnancies reached 37 weeks. In 15 cases of ＂poor outcomes＂ chorioamnionitis was found. Prolapsed membranes, advanced cervical dilatation were associated with a poor outcome. Conclusion Emergency cerclage appears beneficial for cervical insufficiency,but success is indeed partly predictable,with external os 〉2 cm.