腹腔镜下宫颈环扎术与经阴道宫颈环扎术治疗妊娠合并宫颈机能不全的对照研究

A comparative study of laparoscopic cervical cerclage and transvaginal cervical cerclage in the treatment of pregnancy complicated with cervical insufficiency

目的通过与传统经阴道宫颈环扎术对比,评估腹腔镜下宫颈环扎术治疗妊娠合并宫颈机能不全的临床疗效。方法研究对象为本院妇产科2019年1月至12月完成手术的妊娠合并宫颈机能不全患者,共65例,其中腹腔镜下宫颈环扎术32例[治疗组,年龄(28.75±3.94)岁]、经阴道宫颈环扎术33例[对照组,年龄(30.97±5.55)岁]。对比两组术中情况及术后妊娠结局、有无宫颈裂伤等各项指标,评估两种术式的有效率。结果所有患者手术过程均顺利完成,术中均未发生误伤宫旁血管引起大出血、肠道损伤、膀胱损伤、麻醉意外、宫颈断裂等手术并发症,两组术中出血量、手术时间差异均无统计学意义(均P>0.05),治疗组住院天数短于对照组[(7.03±1.33)d比(7.67±0.74)d](P<0.05)。对照组术后出现死胎、早产及宫颈裂伤发生率均高于治疗组(10/33比2/32,10/33比0/32),两组差异均有统计学意义(均P<0.05),两组环扎带断裂、移位发生率差异无统计学意义(P>0.05)。两组新生儿体质量差异无统计学意义(P>0.05),治疗组与对照组足月产率、新生儿评分差异均有统计学意义[30/32比23/33,(9.87±0.34)分比(9.57±0.58)分](均P<0.05)。结论腹腔镜下宫颈环扎术对妊娠合并宫颈机能不全患者进行治疗,与传统的经阴道宫颈环扎术比较,手术成功率高,能显著延长妊娠周数,改善妊娠结局,降低宫颈撕裂发生率,达到研究预期目标,取得良好的医疗和社会效益,值得临床推广应用。

Objective To evaluate the clinical effect of laparoscopic cervical cerclage in the treatment of pregnancy complicated with cervical insufficiency compared with that of traditional transvaginal cervical cerclage.Methods The research objects were 65 patients with pregnancy and cervical insufficiency who received surgical treatment in the Department of Gynecology and Obstetrics of our hospital from January to December 2019.Among the 65 patients,32 patients with an age of(28.75±3.94)years old received laparoscopic cervical cerclage(treatment group),and 33 patients with an age of(30.97±5.55)years old received transvaginal cervical cerclage(control group).The efficacies of the two surgical approaches were evaluated based on the comparison of the situation during the operation,pregnancy outcomes,and cervical laceration.Results All the patients received successful surgeries without surgical complications during the operation,such as massive hemorrhage caused by accidental injury of parametrial blood vessels,intestinal injury,bladder injury,anesthesia accident,or cervical laceration.The intraoperative blood loss and the duration of operation showed no statistically significant differences between the two groups(both P>0.05);the hospital stay in the treatment group was shorter than that in the control group[(7.03±1.33)d vs.(7.67±0.74)d](P<0.05).The incidences of postoperative stillbirth and premature delivery,and cervical laceration in the control group were higher than those in the treatment group(10/33 vs.2/32,10/33 vs.0/32)(both P<0.05);the incidence of fracture and displacement of ring band showed no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in the neonatal body weight between the two groups(P>0.05),but there were statistically significant differences in the rate of full-term birth and neonatal score between the treatment group and the control group[30/32 vs.23/33,(9.87±0.34)vs.(9.57±0.58)](both P<0.05).Conclusions Compared with traditional transvaginal cervical cerclage,laparoscopic cervical cerclage in the treatment of pregnancy complicated with cervical insufficiency,has a higher surgical success rate,and can significantly extend the duration of pregnancy,improve the pregnancy outcomes,and decrease the occurrence of cervical laceration.It has reached the research expectation,can produce satisfying medical and social benefits,and therefore is worth for promotion in the clinical application.