体外受精-胚胎移植术前与孕早期腹腔镜宫颈环扎术的比较

Comparative Analysis of Laparoscopic Transabdominal Cervicoisthmic Cerclage Before IVF-ET and at Early-pregnant Period

目的探讨合并宫颈机能不全的体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)行腹腔镜宫颈环扎术(laparoscopic transabdominal cervicoisthmic cerclage,LTCC)的时机。方法回顾性分析2017年3月~2020年3月122例IVF-ET合并宫颈机能不全患者行LTCC的临床资料,其中孕前手术98例(孕前组),早孕期手术24例(早孕组),对比2组手术时间、术中出血量、术后住院时间、围手术期并发症、分娩结局、新生儿情况等。结果2组LTCC手术均获成功。孕前组手术时间短[(18.6±3.6)min vs.(32.2±4.1)min,t=-17.196,P=0.000],术后住院时间短[(3.1±0.9)d vs.(5.2±1.1)d,t=-8.827,P=0.000],2组手术出血量、围手术期并发症发生率以及妊娠结局、分娩孕周、新生儿窒息率及出生体重差异均无统计学意义(P>0.05)。结论IVF-ET合并宫颈机能不全患者在孕前或早孕期进行LTCC手术均安全有效,但孕前手术较早孕期使患者获益更多。

Objective To explore the surgery opportunity choice of laparoscopic transabdominal cervicoisthmic cerclage(LTCC)in cervical incompetence patients who underwent in vitro fertilization and embryo transfer(IVF-ET).Methods The data of 122 patients with cervical incompetence undergoing LTCC before or after IVF-ET were analyzed retrospectively from March 2017 to March 2020.The patients were divided into pre-pregnancy group(n=98)and early-pregnancy group(n=24).Perioperative conditions and reproductive outcomes were analyzed respectively,including operation time,intraoperative blood loss,postoperative hospital time,perioperative complications,delivery outcomes and neonate outcomes.Results LTCC was performed successfully in both groups.The operation time[(18.6±3.6)min vs.(32.2±4.1)min,t=-17.196,P=0.000]and postoperative hospital time[(3.1±0.9)d vs.(5.2±1.1)d,t=-8.827,P=0.000]of pre-pregnancy group were significantly shorter than that of the early-pregnancy group.There was no significant difference between the two groups in blood loss,perioperative complications rate,gestational results,neonatal asphyxia rate,or neonate birth weights.Conclusion LTCC can be performed in pre-pregnancy and early-pregnancy in IVF-ET and cervical incompetence patients,and pre-pregnancy group benefits more from it.