预防性宫颈环扎术治疗宫颈机能不全效果及其影响因素分析

Efficacy of prophylactic cervical cerclage for treating cervical incompetence and its influencing factors

目的:探究预防性宫颈环扎术治疗宫颈机能不全疗效及预后影响因素。方法:回顾性收集本院2017年3月—2019年3月收治的行预防性宫颈环扎术治疗宫颈机能不全患者65例为预防组,同期行治疗性宫颈环扎术的宫颈机能不全患者65例为治疗组,比较两组手术出血量、术后住院时间,分娩孕周、妊娠32周宫颈长度、妊娠结局,孕周延长时间、新生儿情况,疗效影响因素分析。结果:手术后,预防组手术出血量((27.3±5.7 ml)、术后住院时间(6.6±2.2 d))低于治疗组,分娩孕周(37.8±4.2周)、妊娠32周宫颈长度(3.1±0.2 cm)、足月生产率(88.9%)、孕周延长时间(9.5±2.5周)、新生儿体质量(2879.34±235.64g)、新生儿存活率(92.3%)均高于治疗组(均P<0.05)。预防组治疗效果与孕妇年龄、术前侵入性操作有相关性(P<0.05),与围手术期是否应用孕酮、有无子宫颈手术史、早产史或晚期流产史、手术时间等因素无相关(P>0.05)。孕妇年龄较大、有术前侵入性操作为预防性宫颈环扎术疗效的独立危险因素(P<0.05)。结论:预防性宫颈环扎术治疗宫颈机能不全患者可明显减少手术出血量及术后住院时间,延长孕周,提高足月生产率、新生儿存活率及质量,其疗效受患者年龄、术前侵入性操作影响。

Objective:To explore the efficacy factors of prophylactic cervical cerclage for treating women with cervical incompetence,and to study it’s influencing on prognostic.Methods:From March 2017 to March 2019,65 women with cervical incompetence who had accepted prophylactic cervical cerclage were in study group,and 65 patients with cervical incompetence who had accepted therapeutic cervical cerclage were in control group during the same period.The bleeding amount during operation,postoperative hospital stay time,gestational weeks when delivery,cervical length in the 32rd gestational week,pregnancy outcomes,extension gestational weeks after operation,or neonatal situations of women was compared between the two groups.The influencing factors of curative effect of women in the two groups were also analyzed.Results:After operation,the amount of bleeding(27.3±5.7 ml)and postoperative hospital stay(6.6±2.2 d)of women in the study group were significant lower than those of women in the control group,but the gestational weeks when delivery(37.8±4.2 weeks),cervical length in the 32rd gestational week(3.1±0.2 cm),the rate of full-term delivery(88.9%),extension gestational week after operation(9.5±2.5 weeks),neonatal body weight(2879.34±235.64g),and neonatal survival rate(92.3%)of women in the study group were significant higher(all P<0.05).The therapeutic effects of women in the study group were significantly correlated with their age and preoperative invasive manipulation(P<0.05),but were not correlated with perioperative progesterone used,the history of cervical surgery,the history of premature delivery or late abortion,and the operation time(P>0.05).Older pregnant women and invasive manipulation before operation were independent risk factors of preventive cervical cerclage(P<0.05).Conclusion:Prophylactic cervical cerclage for treating women with cervical incompetence can significantly reduce the amount of bleeding during operation and postoperative hospital stay time,prolong gestational weeks,improve full-term delivery rate,and improve neonatal survival rate and quality,which’s curative effect is affected by the age of women and preoperative invasive manipulation.