不同宫颈环扎术治疗宫颈机能不全的妊娠结局分析

Analysis of pregnancy outcome of different cervical cerclage in the treatment of cervical insufficiency

目的 研究不同宫颈环扎术对宫颈机能不全(CI)患者的临床效果。方法 分析2009年4月至2022年2月在空军军医大学西京医院妇产科确诊为CI并接受不同宫颈环扎术治疗的527例患者的临床资料,其中,经阴道预防性宫颈环扎378例、经阴道紧急性宫颈环扎71例、腹腔镜下宫颈环扎65例、机器人辅助下宫颈环扎10例、经阴道子宫托放置3例,对各自的妊娠结局进行分析。结果 经阴道预防性宫颈环扎组宫颈管长度、孕周延长时间、新生儿体质量及分娩孕周均高于经阴道紧急性宫颈环扎组(P<0.05)。腹腔镜下宫颈环扎组的新生儿体质量、分娩孕周均高于经阴道紧急性宫颈环扎组(P<0.05),宫颈管长度差异无统计学意义(P>0.05)。经阴道预防性宫颈环扎组的宫颈管长度较腹腔镜下宫颈环扎组更长(P<0.05),分娩孕周大于腹腔镜下宫颈环扎组(P<0.05),新生儿体质量差异无统计学意义(P>0.05)。经阴道预防性宫颈环扎妊娠成功率为95.2%,经阴道紧急性宫颈环扎妊娠成功率仅为56.3%,腹腔镜下宫颈环扎妊娠成功率为98.5%。机器人辅助下宫颈环扎组和经阴道子宫托放置组的样本量过少,随机误差很大,得出的结论不具有代表性。结论 宫颈环扎术是目前治疗CI最安全有效的手术方式;经阴道预防性宫颈环扎成功率较高,腹腔镜下宫颈环扎与经阴道预防性宫颈环扎无明显差异;经阴道子宫托放置术,后续还需增加样本量,进一步验证CI治疗的结果。

Objective To study the clinical effect of different cervical cerclage on patients with cervical insufficiency(CI).Methods The clinical data of 527 patients diagnosed with CI and treated with different cervical cerclage in the Department of Obstetrics and Gynecology,Xijing Hospital,Air Force Medical University from April 2009 to February 2022 were analyzed.There were 378 cases of transvaginal prophylactic cervical cerclage,71 cases of transvaginal emergency cervical cerclage,65 cases of laparoscopic cervical cerclage,10 cases of robot-assisted laparoscopic cervical cerclage,and 3 cases of transvaginal pessary placement.The pregnancy outcomes were analyzed,respectively.Results The pregnancy success rate of transvaginal prophylactic cervical cerclage was 95.2%,only 56.3%transvaginal emergency cervical cerclage was succeed,and the success rate of laparoscopic cervical cerclage was 98.5%.Age and times of pregnancy and childbirth had no effect on the choice of cervical cerclage.The length of cervical canal,prolonged gestational week,neonatal body mass and gestational week of delivery in the transvaginal prophylactic cervical cerclage group were higher than those in the transvaginal emergency cervical cerclage group(P<0.05).The body mass and gestational weeks of newborns in the laparoscopic cervical cerclage group were higher than those in the transvaginal emergency cerclage group(P<0.05),and there was no significant difference in the length of cervical canal(P>0.05).The length of cervical canal in the transvaginal prophylactic cervical cerclage group was longer than that in the laparoscopic cervical cerclage group(P<0.05).The gestational weeks of delivery in the transvaginal prophylactic cervical cerclage group were greater than those in the laparoscopic cervical cerclage group(P<0.05).There was no significant difference in neonatal body mass(P>0.05).The success rate of pregnancy of transvaginal prophylactic cervical cerclage was 95.2%,the success rate of pregnancy of transvaginal emergency cervical cerclage was 56.3%,and the success rate of pregnancy of laparoscopic cervical cerclage was 98.5%.The sample size of the robot-assisted laparoscopic cervical cerclage group and the transvaginal pessary placement group was too small,and the random error was large,so the conclusions drawn were not representative.Conclusion Cervical cerclage is the safest and the most effective surgical method for the treatment of CI.The success rate of transvaginal prophylactic cervical cerclage is high,and there is no significant difference between laparoscopic cervical cerclage and transvaginal prophylactic cervical cerclage.The sample size of the transvaginal pessary placement group needs to be increased to further verify this result in the treatment of CI.