腹腔镜非孕期宫颈环扎松紧度临床疗效的探讨

Discussion on the clinical efficacy of laparoscopic cervical cerclage with different tightness in non-pregnant period

目的比较经腹腔镜非孕期宫颈环扎不同松紧度的临床疗效。方法回顾性分析2016年1月至2021年7月在广州医科大学附属第六医院就诊的52例宫颈机能不全患者的病例资料,环扎松紧度为6.0号扩宫条可顺利通过,6.5号扩宫条有阻力通过的患者31例为对照组(A组);环扎松紧度为7.0或7.5号扩宫条可顺利通过,7.5或8.0号扩宫条有阻力通过的患者21例为研究组(B组)。比较两种环扎松紧度对术后妊娠率、孕期反复安胎率、剖宫产术中出血量、术后并发症等方面的影响。结果A组的妊娠率(≥12周)、孕期反复安胎率高于B组,但差异无统计学意义(P>0.05);两组剖宫产术中出血量、分娩孕周及新生儿出生体重比较,差异无统计学意义(P>0.05);A组已分娩活产率高于B组(P<0.05);A组中有3例患者术后因并发症而被迫拆除缝线,与B组比较差异无统计学意义(P>0.05)。结论两种宫颈环扎松紧度均具有较好的临床疗效,但环扎过紧可能导致患者术后因并发症而被迫拆线,因此腹腔镜下非孕期环扎松紧度为7.0或7.5号扩宫条可顺利通过,7.5或8.0号扩宫条有阻力通过可能更加安全,值得尝试和推广。

Objective To compare the clinical efficacy of different tightness of cervical cerclage through laparoscopic in non-pregnant period.Methods To retrospectively analyze the data of 52 cases of patients with cervical insufficiency who were treated in the Sixth Affiliated Hospital of Guangzhou Medical University from January 2016 to July 2021.31 patients who were No. 6.0 dilatation strips can pass through smoothly, while the No. 6.5 dilation strips passing through with resistance are included in the control group(group A),21 patients who were No. 7.0 or 7.5 dilatation strips can pass through smoothly, while the No. 7.5 or 8.0 dilation strips passing through with resistance are included in the study group(group B),to compare the clinical efficacy of the two cerclage tightness in the rate of repeated treating of threatened abortion, blood loss during cesarean section and postoperative complications.Results The pregnancy rate, the rate of repeated treating of threatened abortion of group A(≥12 weeks) were higher than those in group B,but the difference was not statistically significant(P>0.05);the blood loss during cesarean section, the gestational age of delivery and the birth weight of the newborn were similar in two groups(P>0.05);The live birth rate of group A was higher than that of group B(P<0.05);There were 3 patients in group A who were forced to remove the Mersilene tape due to postoperative complications, and there was no significant difference compared with group B(P>0.05).Conclusion Both two cervical cerclage tightness recieve good clinical effects, however, if the cerclage is too tight, the patient may be forced to remove the Mersilene tape due to complication.Therefore, maybetightness of cervical cerclage through laparoscopic in non-pregnant period with No. 7.0 or 7.5 dilatation strips can pass through smoothly, while the No. 7.5 or 8.0 dilation strips passing through with resistance is safer and worthy of try and promotion.