腹腔镜下子宫颈环扎术治疗妊娠16~21周子宫颈机能不全的临床效果观察

Clinical effect of laparoscopic cervical cerclage in the treatment of cervical incompetence at 16-21 weeks of gestation

目的探讨腹腔镜下子宫颈环扎术治疗妊娠16~21周子宫颈机能不全的临床效果和安全性。方法回顾性分析2016年6月至2022年7月于南京医科大学第二附属医院行腹腔镜下子宫颈环扎术治疗的妊娠16~21周子宫颈机能不全患者共计40例的临床资料,观察术中术后情况、术后子宫颈管长度、子宫颈内口宽度、术后延长孕周情况、术后妊娠结局及新生儿预后。结果40例患者,30例单胎妊娠,10例双胎妊娠,环扎平均孕周(17.8±1.5)周,手术过程顺利,无一例中转开腹,无一例发生胎膜早破,无一例发生感染。环扎术后子宫颈管长度,由孕前(25.2±8.4)mm增加至环扎术后的(31.1±3.4)mm(P<0.001)。术后子宫颈内口宽度由术前的(5.6±2.0)mm缩小至术后的0mm(P<0.001)。分娩孕周(36.6±2.3)周,较前延长(18.8±2.6)周,4例流产,占比10.0%,36例活产,占比90.0%,共45个活产儿。胎儿出生后1min Apgar评分(9.3±0.9)分,胎儿出生体重(2636.2±614.8)g,其中极低体重儿2例,远期随访,新生儿预后良好。结论子宫颈机能不全行腹腔镜下子宫颈环扎术是可行的、安全的,可增加子宫颈管长度、缩小子宫颈内口宽度、延长孕周,胎儿生长发育不受限,有良好的妊娠结局。

Objective To investigate the clinical efficacy and safety of laparoscopic cervical cerclage in the treatment of cervical incompetence at 16 to 21 weeks of gestation.Methods The clinical data of a total of 40 patients with cervical incompetence at 16-21 weeks of pregnancy admitted to the Second Affiliated Hospital of Nanjing Medical University from June 2016 to July 2022 were reviewed,and the postoperative situation,postoperative cervical canal length,internal cervical opening width,postoperative prolongation of gestational week,postoperative pregnancy outcome and neonatal prognosis were observed.Results Among the 40 patients,30 were singleton pregnancies and 10 were twins,with an average gestational age of cerclage being(17.8±1.5)weeks;the surgical process was smooth,no patient was transferred to the abdominal surgery,no one had premature rupture of membranes,and no one had infection.The length of cervical canal increased from(25.2±8.4)mm before pregnancy to(31.1±3.4)mm(P<0.001)after cerclage.The width of the internal cervical ostium was reduced from(5.6±2.0)mm before surgery to 0mm(P<0.001)after surgery.The gestational week of delivery was(36.6±2.3)weeks,and the gestational week was extended by(18.8±2.6)weeks compared with the previous period.There were 4 cases of miscarriage,accounting for 10.0%,36 live births,accounting for 90.0%,and there were 45 live birth children.After birth,the Apgar score at 1 minute was(9.3±0.9)and the fetal birth weight was(2636.2±614.8)g,including 2 very low birth weight infants.The long-term follow-up showed that the prognosis of the newborn was good.Conclusion Laparoscopic cervical cerclage for patients with cervical incompetence is feasible and safe,which can increase the length of the cervical canal,reduce the width of the internal cervical opening and prolong the gestational week.The fetal growth and development is not restricted and the pregnancy outcomes are good.