孕期宫颈双重环扎术治疗宫颈功能不全的临床效果评价

Analysis of effect of pregnancy with double loop cerclage for cervical incompetence

目的：观察孕期宫颈双重环扎术治疗宫颈功能不全的疗效。方法将80例宫颈功能不全的患者按手术方式不同分为两组，每组各40例，于妊娠15～20周施术，治疗组行宫颈双重环扎，对照组行McDonald 法单线环扎，观察两组手术情况、术后宫颈长度及妊娠结局。结果两组手术时间及出血量差异无统计学意义；术后治疗组宫颈长度（4．63±0．52）cm，对照组（3．71±0．82）cm，治疗组长于对照组（t ＝2．106， P ＜0．05）。妊娠结局：治疗组足月分娩20例（50．0％），早产18例（45．0％）（34～37周12例，28～34周6例），胎儿成活36例（90．0％），孕28周以下难免流产2例（5．0％），未存活，平均分娩孕周35．2周，较术前平均流产孕周延长13．5周，新生儿体质量（3200±200）g；对照组足月分娩14例（35．0％），早产20例（50．0％）（34～37周7例，28～34周13例），胎儿成活33例（82．5％），孕28周以下难免流产4例（10．0％），无流产儿存活，平均分娩孕周33．2周，较术前平均流产孕周延长11．5周，新生儿体质量（2900±300）g。治疗组足月分娩率、胎儿成活率、新生儿体质量均高于对照组，差异有统计学意义（χ^2＝7．83，P ＜0．05）。结论孕中期宫颈双重环扎术能够维持有效的宫颈长度，延长孕周，提高围产儿存活率。

Objective To observe the effect of pregnancy double loop cerclage for cervical incompetence. Methods 80 cases of cervical function incompetence according to the type of surgery were divided into two groups, 40 cases in each group,15 -20 weeks of surgery in pregnancy,the treatment group underwent double loop cerclage, the control group underwent McDonald single cerclage.The operation,postoperative cervical length and pregnancy outcome of the two groups were observed.Results There was no difference in operation time and blood loss between the two groups.The length of cervix in the treatment group was （4.63 ±0.52）cm,which was longer than （3.71 ± 0.82）cm of the control group（t =2.106,P 〈0.05）.Pregnancy outcome：20 cases of the treatment group in term birth （50%）,preterm birth in 18 cases （45%）（34 -37 weeks in 12 cases,28 -34 weeks in 6 cases）,fetal survival in 36 cases （90%）,less than 28 weeks pregnant inevitable abortion in 2 cases （5%）,abortion did not survive.Average delivery gestational age was 35.2 weeks,and preoperative average abortion pregnant weeks contrast,treatment group delivery gestational weeks extended 13.5 weeks,the average weight of newborns was （3 200 ±200）g.The control group of full -term delivery was 14 cases （35%）,premature in 20 cases （50%）（34 -37 weeks in 7 cases and 13 cases of 28 -34 weeks）,fetal survival in 33 cases （82.5%）,less than 28 weeks pregnant inevitable abortion in 4 cases （10%）,abortion did not survive.Average delivery gestational age was 33.2 weeks,compared with the average abortion weeks before operation,the gestational age of the control group was extended by 11.5 weeks.The weight of newborn was （2 900 ±300）g.In the treatment group,the term labor rate,fetal survival rate,neonatal weight were higher than those of the control group,the difference was statistically significant （χ^2 =7.83,P 〈0.05）.Conclusion The second trimester cervical double cerclage can maintain effective cervical length,prolong gestational age,improve perinatal survival rate.