腹腔镜下宫颈环扎术在宫颈机能不全治疗中的应用及时机选择

Application and timing selection of laparoscopic cervical cerclage in the treatment of patients with cervical insufficiency

目的探讨腹腔镜下宫颈环扎术在宫颈机能不全(CI)治疗中的临床疗效以及手术时机的选择。方法回顾性分析2019年6月—2022年12月在苏北人民医院就诊的120例CI患者的临床资料。根据孕期及手术方式的不同,将患者分为孕前腹腔镜组(n=45)、孕早期腹腔镜组(n=42)和经阴道组(n=33,经阴道宫颈环扎术)。记录患者的住院时间、手术时间、术中出血量以及孕期保胎率等指标。随访收集患者的妊娠情况,分析3组患者的妊娠结局,总结不同孕期阶段的手术选择原则。结果孕前腹腔镜组和孕早期腹腔镜组术中出血量、住院时间和孕期保胎率均低于经阴道组,差异有统计学意义(P<0.01);3组在手术时间方面比较,差异均无统计学意义(P>0.05)。与经阴道组相比,孕前腹腔镜组和孕早期腹腔镜组流产率和早产率降低,足月产率以及分娩孕周提高,差异均有统计学意义(P<0.05)。孕前腹腔镜组相较于孕早期腹腔镜组有较低的早产率,差异有统计学意义(P=0.044)。结论腹腔镜宫颈环扎术可有效改善CI患者的妊娠结局,提高足月产率以及分娩孕周,降低流产率及早产率。孕前腹腔镜宫颈环扎术在降低早产率以及手术风险方面略有优势。

Objective To explore the therapeutic effect and surgical timing selection of laparoscopic cervical cerclage in the treatment of patients with cervical insufficiency(CI).Methods Clinical materials of 120 patients with CI in Northern Jiangsu People′s Hospital from June 2019 to December 2022 were retrospectively analyzed.According to the different stages of pregnancy and surgical methods,the patients were divided into pre-pregnancy laparoscopy group(n=45),early pregnancy laparoscopy group(n=42)and transvaginal group(n=33,treated with vaginal cerclage).Indexes such as hospital stay,operation time,intraoperative bleeding volume and fetal protection rate during pregnancy were recorded.Follow-up was performed to collect information on patients′pregnancy outcomes,the pregnancy outcomes of the three groups were analyzed,and the surgical selection principles for different stages of pregnancy were summarized.Results The intraoperative bleeding volume,hospital stay and fetal protection rate during pregnancy in the pre-pregnancy laparoscopy group and early pregnancy laparoscopy group were significantly lower than those in the transvaginal group(P<0.01);there was no significant difference in operation time among the three groups(P>0.05).Compared with the transvaginal group,the abortion rate and premature birth rate in the pre-pregnancy laparoscopy group and early pregnancy laparoscopy group were significantly lower,while the full-term birth rate and gestational week at delivery were significantly higher(P<0.05).The pre-pregnancy laparoscopy group had a significant lower premature birth rate compared to the early pregnancy laparoscopy group(P=0.044).Conclusion Laparoscopic cervical cerclage can effectively improve the pregnancy outcomes of patients with CI,increase full-term birth rate and gestational week at delivery,and reduce abortion rate and premature birth rate.Pre-pregnancy laparoscopic cervical cerclage has slight advantages in reducing the premature birth rate and surgical risks.