不同妊娠时机经阴道宫颈环扎术治疗宫颈机能不全的疗效分析

Therapeutic effect of transvaginal cervical cerclage for cervical insufficiency at different gestational stage

目的探讨不同妊娠时机行经阴道宫颈环扎术治疗宫颈机能不全的临床疗效。方法回顾性分析2017年1月至2021年11月于南京医科大学附属泰州市人民医院因宫颈机能不全行经阴道宫颈环扎术且有明确妊娠结局的患者51例,按不同妊娠时机的手术指征分为超声指征组(16例)、病史指征组(27例)及体格检查组(8例)。对3组基本临床特征、发生宫颈机能不全的高危因素、妊娠结局(延长孕周、分娩孕周、产后出血、胎膜早破)及新生儿结局进行评估。结果病史指征组孕次3.00(2.00,5.00)次,明显大于超声指征组的2.00(1.00,4.00)次及体格检查组的2.00(1.25,2.00)次,病史指征组环扎孕周为14.00(13.00,16.00)周,显著小于超声指征组的21.50(16.25,24.00)周及体格检查组的23.00(22.00,25.50)周,差异均有统计学意义(P<0.05)。病史指征组延长孕周22.00(15.00,24.00)周,显著多于超声指征组的13.50(12.00,19.00)周及体格检查组的9.50(4.25,11.75)周(P<0.05);病史指征组胎膜早破率(3.70%)显著低于体格检查组(37.50%)及超声指征组(25.00%),差异有统计学意义(P<0.05)。结论病史指征明确的宫颈机能不全患者尽早行宫颈环扎术可有效延长孕周,减少胎膜早破发生,增加新生儿存活率。

Objective To investigate the therapeutic effect of transvaginal cervical cerclage at different gestational stages on the treatment of cervical incompetence.Methods A retrospective study was performed on 51 pregnant women with cervical insufficiency who underwent transvaginal cervical cerclage and had known pregnancy outcome in the Department of Obstetrics and Gynecology at Taizhou People's Hospital affiliated to Nanjing Medical University from January 2017 to November 2021.According to the surgical indications at different gestational stage,they were divided into the ultrasound indication group(16 cases),the history indication group(27 cases)and the physical indication group(8 cases).Basic clinical characteristics,high risk factors for cervical insufficiency,pregnancy outcome(extended gestational week,gestational week,postpartum hemorrhage and premature rupture of membranes)and neonatal outcome were evaluated in the three groups.Results The gravida in the history indication group was more than those in the ultrasound indication group and in the physical indication group[3.00(2.00,5.00)vs 2.00(1.00,4.00)and 2.00(1.25,2.00),P<0.05].The gestational age(weeks)upon cerclage in the history indication group was earlier than those in the ultrasound indication group and in the physical indication group[14.00(13.00,16.00)vs 21.50(16.25,24.00)and 23.00(22.00,25.50),P<0.05].The extended gestational week in the history indication group was better than those in the ultrasound indication group and in the physical indication group[22.00(15.00,24.00)vs 13.50(12.00,19.00)and 9.50(4.25,11.75),P<0.05].The occurrence of premature membrane rupture in the history indication group was lower than those in the physical indication group and in the ultrasound indication group[1(3.70%)vs 3(37.50%)and 4(25.00%),P<0.05].Conclusion Transvaginal cervical cerclage as early as possible in patients with definite indications of medical history for cervical insufficiency can effectively prolong pregnancy,reduce the incidence of premature rupture of membranes and increase the survival rate of neonate.