19例宫颈紧急环扎术的临床分析

Clinical analysis of 19 cases of cervical emergency ligation

目的探讨宫颈机能不全的诊断及病因及紧急宫颈环扎术的临床价值。方法选取2017年10月~2018年10月我科收治的孕中晚期难免流产患者并行紧急宫颈环扎术19例(双胎妊娠5例,单胎14例),对其临床资料进行回顾性分析。结果宫颈机能不全高危因素主要为自然流产11例(1~5次),阴道分娩史7例,1~2次,孕4个月以上引产3例(1~3次),孕晚期流产史3例,宫颈锥切史1例。19例手术均顺利完成,术后宫颈有效长度8~20mm,孕期延长5~121d,除2例发生流产,新生儿未存活,余21例均获得存活新生儿,出生体重1400~3800g,1例产后7d新生儿坏死性小肠炎,其他21例无并发症发生。结论多次流产、妊娠、宫颈手术史孕妇应警惕宫颈机能不全,作为针对宫颈机能不全致晚期难免流产的援救性手术,紧急宫颈环扎术能有效延长孕周,明显改善妊娠结局。

Objective To investigate the diagnosis and cause of cervical insufficiency and the clinical value of emergency cervical cerclage. Methods From October 2017 to October 2018, 19 patients with inevitable abortion in the middle and late stage of pregnancy were enrolled in this study(19 cases of twin pregnancy and 14 cases of singleton). The clinical data were retrospectively analyzed. Results The high risk factors of cervical insufficiency were mainly spontaneous abortion in 11 cases (1-5 times), vaginal delivery history in 7 cases (1-2 times), pregnancy induced by 3 cases(1-3 times)in April, and abortion history in late pregnancy. 3 cases, 1 case of cervical conization history. All the 19 cases were successfully completed. The effective length of the cervix was 8-20 mm, and the pregnancy was extended by 5 to 121 days. Except for 2 cases of abortion, the newborn did not survive. The remaining 21 cases were all surviving newborns, and the birth weight was 1400-3800 g. One case of neonatal necrotizing enteritis was 7 days after birth, and the other 21 cases had no complications. Conclusion Pregnant women with multiple abortion, pregnancy and cervical surgery should be alert to cervical insufficiency. As a rescue operation for inevitable abortion in the late stage of cervical dysfunction, emergency cervical cerclage can effectively prolong gestational age and significantly improve pregnancy outcome.