两种Shirodkar宫颈环扎术式对单胎宫颈机能不全孕妇妊娠结局的影响

Pregnancy outcomes of singleton pregnant women with cervical insufficiency receiving Shirodkar cervical cerclage with or without buried sutures

目的探讨Shirodkar埋线环扎术式与Shirodkar非埋线环扎术式对单胎宫颈机能不全孕妇妊娠结局的影响。方法选取2021年2月—2023年12月因病史指征或超声指征在同济大学附属东方医院产科行经阴道宫颈环扎术(Shirodkar术式)的373例宫颈机能不全单胎妊娠孕妇为研究对象。完整收集孕妇的一般临床资料和母婴结局,根据术中是否将缝线线尾包埋于阴道黏膜下,分为Shirodkar埋线环扎术式组(埋线环扎组,n=115)组和Shirodkar非埋线环扎术式组(非埋线环扎组,n=258)。使用独立样本t检验、秩和检验、χ^(2)检验或Fisher精确概率检验比较两组孕妇的一般临床资料、孕妇妊娠结局及新生儿结局,并采用多因素Logistic回归模型分析评估早产和妊娠36周前拆线发生的危险因素。结果与非埋线环扎组相比,埋线环扎组早产率降低(13.0%vs 22.5%,P=0.048),妊娠36周前拆线率降低(19.1%vs 33.3%,P=0.005),拆线孕周较晚[37(36.0,37.0)周vs 36(35.0,37.0)周,P<0.001]。两组新生儿结局包括出生体重、入住NICU率、新生儿并发症等方面的差异均无统计学意义(均P>0.05)。多因素Logistic回归分析显示,是否埋线与早产发生风险降低无显著相关,与妊娠36周前拆线发生风险降低相关(OR=0.516,95%CI:0.2930.909,P=0.022);环扎前宫颈长度与早产发生风险降低相关(OR=0.954,95%CI:0.9150.996,P=0.031),与妊娠36周前拆线发生率增加相关(OR=1.062,95%CI:1.0021.104,P=0.002)。结论Shirodkar埋线环扎术式可以延长拆线孕周、降低妊娠36周前拆线率,但该术式在改善妊娠结局方面尚未见明显优势。

Objective To compare the pregnancy outcomes in singleton pregnant women with cervical insufficiency receiving Shirodkar cerclage with or without buried sutures.Methods A total of 373 singleton pregnant women with cervical insufficiency who underwent transvaginal cervical cerclage(Shirodkar technique)at the Obstetrics Department of Tongji University Affiliated East Hospital from February 2021 to December 2023 were enrolled in the study.During the Shirodkar cerclage procedures the sutures were buried in 115 cases(buried suture group)and not buried in 258 cases(non-buried suture group).Independent sample t-tests,rank-sum tests,chi-square tests,or Fisher's exact tests were used to compare general clinical data,pregnancy outcomes,and neonatal outcomes between the two groups.Multivariate Logistic regression models were used to analyze the risk factors for preterm birth and cerclage removal before 36 weeks of gestation.Results Compared with the non-buried suture group,the buried suture group had a lower rate of preterm birth(13.0%vs 22.5%,P=0.048),a lower rate of cerclage removal before 36 weeks(19.1%vs 33.3%,P=0.005),and a later gestational week at cerclage removal[37(36.0,37.0)weeks vs 36(35.0,37.0)weeks,P<0.001].There were no significant differences between the two groups in neonatal outcomes,including birth weight,NICU admission rate,and neonatal complications(all P>0.05).Multivariate Logistic regression analysis showed that the presence of buried sutures was not significantly associated with a reduced risk of preterm birth but was associated with a reduced risk of cerclage removal before 36 weeks(OR=0.516,95%CI:0.293-0.909,P=0.022).Cervical length before cerclage was associated with a reduced risk of preterm birth(OR=0.954,95%CI:0.915-0.996,P=0.031)and an increased rate of cerclage removal before 36 weeks(OR=1.062,95%CI:1.002-1.104,P=0.002).Conclusion The Shirodkar cerclage with buried sutures can prolong gestational age at cerclage removal and reduce the rate of cerclage removal before 36 weeks,but it does not show a significant advantage in improving overall pregnancy outcomes.