127例接受治疗性宫颈环扎术孕妇妊娠结局的影响因素分析

Analysis on influence factors of pregnancy outcomes of therapeutic cervical cerclage in 127 cases

目的探讨接受治疗性宫颈环扎术孕妇不同妊娠结局的影响因素。方法收集因宫颈机能不全2009～2012年于陕西省宝鸡市妇幼保健院接受治疗性宫颈环扎术127例孕妇的临床资料，按照孕周不同分为13—19周组（76例）和20～25周组（51例）；按照宫颈管长度分为〉2．0cm（2．1～2．9cm）组（67例）和≤2．0cm组（60例）；按照缝合方式分为Mcdonald法组（72例）和Shirodkar缝合组（55例）。对比分析上述3种因素对受术孕妇流产、早产、胎膜早破、感染和胎儿存活率等妊娠结局的影响。结果13～19周组与20～25周组受术孕妇的妊娠结局比较，差异无统计学意义（P〉0．05）；宫颈长度〉2．0cm组受术孕妇的流产、早产及胎膜早破发生率低于宫颈长度≤2．0cm组，胎儿存活率高于≤2．0cm组（P〈0．05）；Shirodkar缝合组的受术孕妇流产率和胎膜早破率低于Mcdonald法组（P〈0．05）。结论宫颈长度〉2．0cm的孕妇和选择Mcdonald手术方法进行宫颈环扎术能够提高患者的胎儿存活率，有效改善妊娠结局。

Objective To investigate the influence factors of pregnancy outcomes of therapeutic cervical cerclage. Methods Clinical data of 127 pregnant women who received therapeutic cervical cerclage in Baoji Maternal and Child Health Hospital during 2009 to 2012 were collected, all cases were divided into 13 - 19 w group （ n = 76） and 20 - 25 w group （ n = 51 ） by gestational weeks, who were divided into 〉2. 0 cm group （n =67） and ≤2.0 cm group （n =60） by cervical length, and the women were also divided into Mcdonald group （ n = 72 ） and Shirodkar group （ n = 55 ） by sutured techniques. Pregnancy outcomes as abortion, premature birth, premature rupture of membranes, infection, mortality of neonate were compared between different groups. Results The difference in pregnant outcomes between 13 - 19 w group and 20 - 25 w group had no statistical significance （P 〉0. 05）. The incidences of abortion, premature birth, premature rupture of membranes in 〉 2.0 cm group were lower than ≤2. 0 cm group, while the fetal survival rate was higher than ≤2. 0 cm group （P 〈0. 05）. The incidences of abortion, premature rupture of membranes in Shirodkar group were lower than Mcdonald group （P 〈 0. 05）. Conclusion Preoperative cervical length 〉 2.0 cm and Mcdonald technology can improve pregnancy survival rate and pregnancy outcomes for patients conducted cervical cerclage.