宫颈环扎术治疗宫颈机能不全疗效分析

Curative effect analysis of cervix cerclage on cervical incompetence

目的评价宫颈环扎术（cI）治疗宫颈机能不全（cic）的临床效果。方法选择2008年1月至2014年2月于广州市中西医结合医院行CI的孕12—27周CIC患者52例，其中行非紧急CI者43例（行择期CI者11例，行应激性cI者32例），行紧急cI者9例；单胎妊娠43例，双胎妊娠9例；对比观察治疗效果。结果9例行紧急CI的患者中6例发生晚期流产，手术失败；11例行择期cI者全部获得成功；32例行应激性CI者29例手术成功。行非紧急CI者手术成功率（93．0％）较行紧急CI者（33．3％）显著增高（P〈0．05）。单胎妊娠者手术成功率（90．6％）显著高于双胎妊娠者（44．4％），差异有统计学意义（P〈0．05）。行应激性CI者中，环扎孕周18—22周者手术成功率为87．5％，分娩孕周为（37．43±0．98）周；环扎孕周23—27周者手术成功率为91．7％，分娩孕周为（38．14±1．21）周，二者手术成功率及分娩孕周比较差异均无统计学意义（P〉0．05）。结论对有明确指征的CIC患者行择期CI可有效预防早产及流产，改善新生儿预后。掌握手术时机是手术成功的主要因素。对于双胎妊娠的CIC处理应慎重，其手术效果不及单胎妊娠，应掌握手术适应证。行应激性CI者，其环扎时孕周与手术成功率及分娩孕周无明显相关。

Objective To evaluate the clinical effect of application of cervical cerclage （CI） for recurrent miscarriage and preterm patients caused by cervical incompetence（CIC）. Methods A total of 52 patients with 14 - 27 weeks pregnancy, who underwent elective, stress and emergency CI due to CIC in Guangzhou Hospital of Integrated Traditional and West Medi- cine from January 2008 to February 2014 was selected, in which there were 43 cases with non-emergency cerclage operation （including 11 cases with elective cerclage and 32 cases with stress eerclage） ,9 cases with emergency cerclage. In the 52 ca- ses ,there were 43 cases With singleton pregnancy and 9 cases with gemellary pregnancy. The treatment effectiveness was ob- served and compared. Results In the 9 cases with emergency cerclage, six cases occurred late abortion, which indicated the failure of operation. All of the 11 cases with elective cerclage were successful. And 29 cases out of 32 cases with stress cerclage were successful. The successful rate of non-emergency eerclage operation（ 93.0% ） was significantly higher than that of who had emergency eerclage （ 33.3% ） （ P 〈 0.05 ）. The successful rate of cervical cerclage operation in singleton pregnancy （90. 6% ）was significantly higher compared with gemellary pregnancy（ 44.4% ）and the difference was significant（ P 〈 0.05 ）. In the patients underwent stress cerclage, the surgical success rate （87.5%） and gestational weeks [ （37.43 ± 0.98 ）weeks ] of delivery of the patients whose cerelage gestational age was 18 to 22 weeks had no significant difference compared with those of the patients whose delivery gestational age was 32 - 39 weeks [ 91.7%, （38.14 ± 1.21 ） weeks ] （ P 〉 0.05 ）. Conclusion The patients with a clear indication of CIC treated with CI could effectively prevent premature birth and abortion, obtain good neonates, and improve neonatal prognosis. The main factor influencing the success of operation was the operation timing. More attention should be paid to gemellary pregnancy with the operative indication. In the patients who had the stress CI, there is no obvious correlation between cerclage gestational age and surgical success rate of surgery or delivery gestational age.