不同指征宫颈环扎术治疗宫颈机能不全的临床效果分析

Therapeutic effectiveness of the transvaginal cervical cerclage with different indications for cervical insufficiency

目的宫颈机能不全是复发性中期妊娠流产或早产的重要原因。文中旨在评估不同指征宫颈环扎术对宫颈机能不全患者的治疗效果。方法回顾性分析2018年1月至2020年1月南京大学医学院附属鼓楼医院妇产科实施的61例单胎妊娠行宫颈环扎术的宫颈机能不全孕妇资料。按手术指征分为4组:病史指征组[排除临产或胎盘早剥因素,一次或多次与无痛性宫颈扩张相关的中孕期(14~28周)胎儿丢失,或既往宫颈环扎术指征为中孕期无痛性宫颈扩张者,n=29];体格检查指征组[体检发现中孕期无痛性宫颈扩张者(宫口扩张≥1 cm,伴或不伴羊膜囊外凸出宫颈外口),n=7];超声指征组(具有孕34周前自发性早产史,此次妊娠孕24周前发现宫颈长度缩短<25 mm者,n=12);无明确指征组(无自发性早产病史,此次妊娠孕24周前发现宫颈长度缩短<25 mm且宫颈未扩张者,n=13)。对各组基本临床特征、发生宫颈机能不全的高危因素、妊娠结局(延长孕周、分娩孕周、各周分娩率)及新生儿预后进行评估。结果病史指征组延长孕周优于体格检查指征组[22.29(10.57~24.00)周vs 5.43(3.86~7.50)周,P<0.05]。无明确指征组新生儿出生体重显著高于体格检查指征组、超声指征组(P<0.05)。全部活产儿并发症发生率为32%,且病史指征组并发症发生率显著低于体格检查指征组(18.18%vs 83.33%,P<0.05)。结论病史指征明确的宫颈机能不全患者行宫颈环扎术可有效延长孕周,降低新生儿并发症发生率。

Objective Cervical insufficiency is an important cause of recurrent second trimester abortion or premature delivery.This paper aims to evaluate the therapeutic effect of transvaginal cervical cerclag with different indications on patients with cervical insufficiency.Methods Retrospective analysis was made on the data of 61 women with cervical insufficiency who underwent transvaginal cervical cerclage during single pregnancy in the Department of Obstetrics and Gynecology,Drum Tower Hospital affiliated to Nanjing University Medical School from January 2018 to January 2020.They were divided into 4 groups according to surgical indications:In the history indication group[excluding factors of labor or placental ablation,one or more losses in middle pregnancy(14-28 weeks)associated with painless cervical dilatation,or previous cervical ligation indicating painless cervical dilatation in middle pregnancy,n=29];physical indication group[painless cervical dilatation in middle pregnancy(dilatation of uterine mouth≥1 cm,with or without amniotic sac protrusion of cervical orifical mouth)through physical examination,n=7];In the ultrasound indication group(patients with spontaneous preterm birth 34 weeks before pregnancy and cervical length shortening<25 mm 24 weeks before this pregnancy,n=12);indefinite indication group(no history of spontaneous preterm birth,cervical length shortening<25 mm and no cervical dilatation found 24 weeks before this pregnancy,n=13).Basic clinical characteristics,high risk factors for cervical insufficiency,pregnancy outcome(extended gestational week,gestational week,delivery rate of each week)and neonatal prognosis were evaluated in each group.Results The extended gestational week in the history indication group was better than that in the physical indication group[22.29(10.57-24.00)vs 5.43(3.86-7.50)weeks,P<0.05].The birth weight of neonates in the indefinite indication group was significantly higher than that of the physical indication group and the ultrasound indication group(P<0.05).The complication rate of all live births was 32%,and the complication rate of history indication group was significantly lower than that of physical indication group(18.18%vs 83.33%,P<0.05).Conclusion Transvaginal cervical cerclage in patients with cervical insufficiency with definite indications of medical history can effectively prolong pregnancy and reduce the incidence of neonatal complications.Therefore,emergent transvaginal cervical cerclage is of great clinical significance.