腹腔镜宫颈环扎术的围手术期护理

Perioperative Care of Laparoscopic Cervical Cerclage

目的：探讨孕前及早孕期腹腔镜宫颈环扎术的围手术期护理方法。方法：选择2013年7月—2015年12月于首都医科大学附属复兴医院宫腔镜中心因宫颈机能不全不育行孕前及早孕期腹腔镜宫颈环扎术的患者331例,围手术期护理包括：术前的心理疏导、完善术前准备及手术前后的交接,术后严密观察病情、用药护理及进行活动指导,出院时做好健康宣教,告知注意事项。结果：311例孕前患者实施腹腔镜宫颈环扎术,术后妊娠216例,其中187例妊娠29-39周剖宫产分娩,早产35例,共娩出191个活婴（双胎4例）;21例正在妊娠中;8例于孕中期流产。20例早孕期手术患者实施腹腔镜宫颈环扎术,术后2例超声确认胎儿停止发育行清宫术（其中1例辅助生殖为双胎）,18例妊娠36-39周剖宫产分娩,共娩出19个活婴（双胎1例）。结论：腹腔镜宫颈环扎术可有效预防宫颈机能不全引起的流产或早产,加强围手术期护理,有利于提高手术的效果,达到改善妊娠结局的目的。

Objective：To discuss the perioperative care of laparoscopic cervical cerclage for earlier pregnancy and preconception women.Methods：From July 2013 to December 2015 there were 331 cases who suffered from cervical incompetence and infertility admitted in Hysteroscopic Center of Fuxing Hospital.Among them 20 cases were ongoing early pregnancy.Laparoscopic cervical cerclage was performed.Perioperative care of laparoscopic cervical cerclage for pregnant and preconception women include psychological counseling,perfect preoperative preparation and transition between ward and operating theatre,postoperative close observation of patient′ s conditions,medication care and active guidance,education of health and notes while discharge.Results：There were 311 cases preconception laparoscopic cervical cerclage,216 cases with pregnancy successful after operation,cesarean sections were performed for 187 cases during 29-39 gestation weeks,191 live babies（4 twins）.Among them 35 cases with premature delivery,21 cases with ongoing pregnancy,8 cases with midtrimester abortion.Laparoscopic cervical cerclage was performed during pregnancy in 20 cases.Among them 18 cases with successful delivery,one twins and two other cases with unfortunate abortion.Conclusions：Laparoscopic cervical cerclage can prevent miscarriage or premature birth caused by cervical incompetence effectively.Enhanced the perioperative care is helpful to achieve good surgical outcomes.