孕前LCC治疗宫颈机能不全的多因素疗效分析

Multivariate regression analysis of curative effect of pregestational laparoscopic cervical cerclage in treatment of cervical incompetence

目的探讨孕前腹腔镜下宫颈环扎术(LCC)治疗宫颈机能不全患者的疗效并分析其可能影响因素。方法回顾性分析2012年6月至2014年12月于解放军第153中心医院行孕前腹腔镜下宫颈环扎术且已知妊娠结局的61例宫颈机能不全患者,根据分娩情况分组。A组:分娩孕周≥37周的足月儿37例;B组:分娩孕周<37周的早产存活儿21例。另有3例未分娩活胎的临床资料未行对比分析。分析术后影响患者足月分娩的相关因素。结果新生儿存活率为95.00%(58/61),足月分娩率为63.80%(37/58)。单因素分析显示宫颈长度(χ~2=4.315,P=0.038)、宫颈开口(χ~2=5.100,P=0.024)、多胎妊娠(χ~2=6.046,P=0.014)和合并妊娠期疾病(χ~2=5.974,P=0.015)与术后足月分娩有关;多因素Logistic回归分析显示宫颈长度(OR=0.044,95%CI:0.006~0.302,P=0.001)、宫口开大(OR=19.566,95%CI:3.350~114.263,P=0.001)是影响术后足月分娩的独立因素。结论 LCC术后新生儿存活率高达95.00%、足月分娩率达63.80%,术后足月分娩率与宫颈长度和开口大小密切有关。

Objective To discuss the curative effect of pregestational laparoscopic cervical cerclage（LCC）in the treatment of cervical incompetence and to analyze its possible influencing factors.Methods A total of 61 patients with cervical incompetence who adopted pregestational LCC in No.153 Central Hospital of PLA during June 2012 to December 2014 with known pregnancy outcomes were retrospectively analyzed.And they were grouped according to their situation in delivery.In group A,there were 37 cases whose gestational age were not less than 37 weeks,while in group B,there were 21 cases whose gestational age were less than 37 weeks.In addition,the clinical data of 3 cases who failed to deliver live birth were not involved in the comparison and analysis.The related factors influencing the postoperative full-term delivery of patients were analyzed.Results The survival rate of neonate was 95.00%（58/61）,and the rate of full-term delivery was 63.80%（37/58）.Univariate analysis showed that cervical length（χ~2=4.315,P=0.038）,cervical opening size（χ~2=5.100,P =0.024）,multiple pregnancy（χ~2=6.046,P =0.014）and combined pregnancy disease（χ~2=5.974,P=0.015）were related to postoperative full-term delivery.Multivariate logistic regression analysis showed that cervical length[OR =0.044,95%CI（0.006,0.302）,P =0.001],cervical opening size [OR =19.566,95%CI（3.350,114.263）,P=0.001]were the independent factors influencing postoperative full-term delivery.Conclusion After LCC,the survival rate of neonates reachs up to 95.00%,and the rate of full-term delivery is 63.80%.The rate of postoperative full-term delivery is closely related to the cervical length and the cervical opening size.