非孕期腹腔镜与孕期经阴道宫颈环扎术对治疗宫颈机能不全的疗效比较

The comparison of the clinical efficacy of treatment for cervical insufficiency with laparoscopic cervical cerclage in non-pregnant phase and transvaginal cervical cerclage during pregnancy

目的探讨非孕期腹腔镜与孕期经阴道宫颈环扎术对宫颈机能不全的临床疗效比较。方法纳入2011年1月~2016年1月来院就诊的宫颈机能不全患者57例为研究对象,根据手术方式,将患者分为非孕期实施腹腔镜宫颈环扎术组(试验组)30例和孕期经阴道宫颈环扎术组(对照组)27例。比较两种手术方式的手术时间、手术出血情况、住院时间、妊娠结局,分析两种手术方式对宫颈机能不全的临床疗效。结果两组患者均无中转开腹及手术并发症发生。试验组术中平均出血量、住院天数均少于对照组(P<0.05)。试验组足月(≥37周)分娩比高于对照组(P<0.05)。试验组新生儿平均体重重于对照组(P<0.05)。结论非孕期腹腔镜下宫颈环扎术对治疗宫颈机能不全有较好的临床效果,可明显改善妊娠结局,可在临床推广应用。

Objective To explore the effect of laparoscopic cervical cerclage for treatment of patients with cervical insufficiency in non-pregnant phase.Methods Patients with cervical insufficiency in our hospital from January 2011 to January 2016 were analyzed.According to the surgical methods,patients were divided into test group treated with laparoscopic cervical cerclage,and control group treated with transvaginal cervical cerclage.Related intra-operative and post-operative data as well as pregnancy outcome were compared.Results A total of 57 patients were included,with 30 patients in test group and 27 patients in control group.All of the trial patients were cured without major complications.Intra-operative bleeding volume of test group（11.0±2.4 ml）was significantly lower than that of the control group（27.1±8.3 ml）.Length of stay of test group（2.4±0.7 d）was significantly shorter than that of control group（5.3±0.9 d）（P〈0.05）.The number of full term delivery（gestational age≥37 weeks）of test group was 24 patients（80%）,the number of full term delivery of control group was 14 patients（51.9%）（P〈0.05）.Birth weight of test group（3218±521 g）was significantly higher than that of the control group（2787±586 g）（P〈0.05）.Conclusion Pregnancy outcome of patients with cervical insufficiency can be improved by laparoscopic cervical cerclage.