宫颈机能不全孕期手术方式的探讨

Investigation of the Two Different Surgical Methods for Cervical Incompetence at Pregnant Condition

目的:探讨宫颈机能不全患者孕期适宜的手术方式。方法:回顾性分析2013年7月—2017年7月我院收治的宫颈机能不全孕期患者,单胎妊娠且随访资料完整的患者共67例,其中自愿接受腹腔镜下子宫峡部环扎术30例(研究组),自愿接受经阴道宫颈环扎术37例(对照组)。对两种手术方式的临床效果进行比较。结果:研究组手术时间较对照组长,差异有统计学意义[(48.13±1.85)min vs.(16.24±2.29)min,P=0.00]。而研究组术后平均分娩孕周较对照组显著延长[(37.07±3.15)周vs.(29.11±6.43)周,P=0.00],研究组的流产率(6.67%)、早产率(13.33%)低于对照组(51.35%、35.14%),足月产率(80.00%)高于对照组(13.51%),差异有统计学意义(均P<0.05)。研究组患者住院时间短于对照组,差异有统计学意义[(3.17±0.42)d vs.(5.32±1.63)d,P=0.00]。研究组术中出血量与对照组比较差异无统计学意义(P>0.05)。研究组与对照组术后并发症发生率分别为0%和13.51%,差异有统计学意义(P<0.05)。结论:早孕期腹腔镜下子宫峡部环扎术治疗宫颈机能不全相比中孕期经阴道宫颈环扎术临床治疗效果更好,术后并发症更少,具有较高的可行性、安全性。

Objective：To investigate the suitable surgical method for cervical incompetence during pregnancy.Methods：A total of 67 patients with cervical incompetence during pregnancy from July 2013 to July 2017 in our hospital were enrolled in the retrospective analysis,had naturally conceived single birth with complete follow-up data after laparoscopic uterine isthmus cerclage or transvaginal cervical cerclage were divided into two groups according to two different surgical methods to compare the clinical effect.30 patients in the research group were treated with laparoscopic uterine isthmus cerclage,and the other 37 patients in the control group treated with transvaginal cervical cerclage.Results：Operation time of the research group was higher than the control group [（48.13±1.85） min vs.（16.24±2.29） min,P=0.00].The research group had got a longer average pregnancy period than control group [（37.07 ±3.15） weeks vs.（29.11±6.43） weeks,P=0.00].Postoperative abortion rate（6.67%）and preterm birth rate（13.33%） of research group were obviously lower than that of the control group（P0.05）.The term infant rate of research group（80.00%） was higher than that of the control group（P0.05）.The hospital stay of the research group were less than that of the control group [（3.17±0.42） d vs.（5.32±1.63） d,P=0.00].The complication rate of observation group was 0%,and the control group was 13.51%.The difference was significant（P0.05）.There is no statistical significant difference in terms of the hemorrhage amount during operation between the two groups.Conclusions：Laparoscopic uterine isthmus cerclage in treatment of cervical incompetence at first trimester has better clinical effect and fewer post-operative complications than transvaginal cervical cerclage at second trimester.It has higher feasibility and security.It is worth promoting clinically.