生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破的疗效观察

Effect of Fibrin Glue Combined with Cervical Cerclage on Premature Rupture of Membranes

目的:观察生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,对孕妇、胎儿及新生儿的影响,明确该技术治疗胎膜早破的疗效。方法:我院产科共收治妊娠<30周胎膜早破患者48例,采用生物蛋白胶封堵合并宫颈环扎术治疗胎膜早破,观察治疗后孕妇羊水指数,胎儿双顶径,新生儿出生时体重,及孕妇的副反应。结果:在本次封堵治疗过程中均一次封堵成功,没有不良反应发生,所有孕妇术后阴道流水情况均明显改善,其中有2例孕妇术后1周阴道流水停止。所有孕妇术后羊水漏出量均明显减少,B超检查显示羊水指数均在(6±2)cm,胎儿每周双顶径增长均达到(0.15±0.02)cm,延长孕周最短(5±2)w,10例早产,38例继续妊娠至37 w。新生儿出生时体重为(2000±260)g,无1例发生NRDS。同期没有进行宫颈内封堵仅行药物保胎治疗的10例孕妇,胎龄延长最长达到10 d,最短者24 h内出现早产分娩,早产儿平均体重1400 g,均发生NRDS,有2例放弃治疗,4例在NICU行治疗,最终因各种并发症死亡。48例行封堵治疗孕妇未发生过敏反应,无阴道出血及产后出血和感染等。结论:应用生物蛋白胶结合宫颈环扎术治疗胎膜早破,手术操作简单,可延长了孕周,提高了新生儿成活率,无不良反应,具有广泛的应用前景。

Objective： To observe the effect of fibrin glue combined with cervical cerclage on premature rupture of membranes. Methods： 48 pregnancy patients （pregnancy 〈30 weeks） were treated in hospital. The method of fibrin glue sealing combined with cervical cerclage was applied to treat the premature rupture of membranes. Amniotic fluid index, fetal biparietal diameter, body weight of birth, and maternal side effects was observed after treatment of pregnant women. Results： All patients underwent just one closure. There was no case of adverse reactions, and the volume of postoperative vaginal water was significantly reduced. Two cases of vaginal flow stopped after one week. Leakage of amniotic fluid volume decreased obviously in all patients. B-ultrasound once a week showed the amniotic fluid index were 6：1：2 cm, and fetal biparietal diameter increased 0.15±0.02 cm per week, extending the shortest gestational age （5 ± 2） weeks. 10 cases had premature delivery. 38 cases continued pregnancy to 37 weeks. Neonatus had birth weight of 2000 ± 260g, and did not occur NRDS. Over the same period 10 patients who did not block the cervix miscarriage but only for medical treatment, extended the gestational age up to 10 days, preterm birth within 24 hours for the shortest, and the average weight of 1400 g for premature children, and NRDS occurred. Two gave up treatment, and 4 patients live in NICU treatment, but finally failed due to various complications. 48 cases of pregnant women all had no allergic reaction, no vaginal bleeding, no fever before and after the termination of pregnancy and no postpartum hemorrhage and infection. Conclusion： The fibrin glue combined with cervical cerclage treatment on premature rupture of membranesn has a wide application prospect for its advantages like operating simply, extending the gestational age and improving neonatal survival rate, and without adverse reaction.