《ACOG宫颈环扎术治疗宫颈机能不全指南》解读

The Interpretation of ACOG Cerclage for the Management of Cervical Insufficiency

宫颈机能不全(cervical incompetence,cervical insufficiency,incompetent cervix)是临床诊断性疾病,但其诊断十分模糊,缺乏客观的金标准。医学文献中关于宫颈机能不全的病理生理、筛查、诊断和处理存在争议。2014年2月美国妇产科学会(The American College of Obstetricians and Gynecologists,ACOG)颁布了宫颈环扎术治疗宫颈机能不全指南文件,具有较强的临床实用性。该指南系统复习和汇总了有关宫颈机能不全的定义、病因、诊断、治疗选择中非手术治疗方法及手术治疗,手术的临床注意事项与建议,不宜推荐宫颈环扎术的病情,宫颈环扎术的并发症,增加围手术期干预及术后B超随访评估的意义,无并发症Mc Donald术拆除缝线的时机,未足月前胎膜早破宫颈环扎缝线拆除与保留的选择及早产宫颈环扎缝线拆除与保留的选择等问题的文献依据及证据等级。笔者指出国内目前尚无治疗宫颈机能不全的指南,一般比较强调卧床休息和宫颈环扎手术治疗,欧美国家对宫颈环扎手术的施行,较国内妇产科医生更为慎重。

Cervical incompetence（cervical insufficiency,incompetent cervix） is a clinical diagnosis disease.However,the diagnosis is very fuzzy,lack of objective gold standard.In the medical literature on cervical incompetence its pathological physiology,screening method,diagnosis and treatment is controversial.The United States in February 2014,The American College of Obstetricians and Gynecologists（ACOG） has issued guidelines of the cervical cerclage treatment for cervical incompetence,which is much strong clinical practicability.In this paper,the literature basis and the level of evidence was shown by systematic review and summary about the definition of the cervical incompetence,etiology,diagnosis,treatment options among nonsurgical and surgical modalities,the candidates should not be considered for cervical cerclage morbidity of cervical cerclage,the role of postoperative ultrasonographic assessment for additional perioperative interventions,time of remove sewing material for transvaginal Mc Donald cerclage indicated in patients with no complications,the time of remove out sewing silk of women with cerclage and preterm premature rupture of membranes should be managed.Should cerclage be removed in women with preterm labor etc.Points out that at present there is no guideline for the treatment of cervical incompetence in China,in general more emphasis on bed rest and cervical cerclage operation.Compared with obstetrician and gynecologist in China,European and American doctors is more careful for cervical cerclage surgery.