经腹腔镜预防性宫颈环扎术对孕中晚期并发症及围产结局的影响  

Later complications and perinatal outcomes after trans-laparoscope prophylactic cervical cerclage

作　　者：朱海燕[1] 马宁[2] 徐澈[1] 张李松[1] 赵玉荣[1] ZHU Hai-yan;MA Ning;XU Che;ZHANG Li-song;ZHAO Yu-rong(Department of Gynecology and Obstetric,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China;Center of Hysteroscope,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院妇产科,北京100038 [2]首都医科大学附属复兴医院宫腔镜中心,北京100038

出　　处：《中国医刊》2019年第1期46-50,共5页Chinese Journal of Medicine

基　　金：首都临床特色应用研究与成果推广项目(Z171100001017031)

摘　　要：目的探讨经腹腔镜预防性宫颈环扎术对孕中晚期并发症及围产结局的影响。方法选取2012年1月至2017年1月在首都医科大学附属复兴医院宫腔镜中心行经腹腔镜预防性宫颈环扎术的患者36例作为研究组,另选取同期年龄和体重指数匹配、在首都医科大学附属复兴医院妇科行经阴道预防性宫颈环扎术的患者36例作为对照组,所有患者孕期均在首都医科大学附属复兴医院进行系统保健并分娩。比较分析两组患者的孕中晚期并发症及其围产结局。结果与对照组比较,研究组患者的孕中期流产次数更多[(2.12±1.17)次vs (1.15±1.18)次],手术前宫颈长度更短[(25.34±3.88)mm vs (28.15±5.73)mm],差异有显著性(P<0.05)。研究组的孕期腹痛发生率(38.2%)、孕期住院保胎率(41.2%)、黄体酮使用时间[(28.34±2.78)周]均显著高于对照组[分别为14.7%,17.6%,(3.68±2.63)周],差异有显著性(P<0.05),而孕晚期宫颈长度、孕期阴道炎发生率两组比较差异无显著性(P>0.05)。两组的早产率、分娩孕周、新生儿出生体重、产后出血量比较差异无显著性(P>0.05),研究组环扎带与周围组织粘连率高于对照组(35.3%vs 0),胎膜早破(11.8%)和病理证实的宫腔感染发生率(6.7%)低于对照组(分别为38.2%和25.9%),差异有显著性(P<0.05)。与足月分娩者比较,早产者胎膜早破发生率(71.4%vs 14.0%)、病理证实的宫腔感染发生率(57.1%vs 10.0%)更高,差异有显著性(P<0.01)。Logistic回归分析显示,控制环扎前宫颈长度和内口松弛情况后,病理证实的宫腔感染是早产的唯一高危因素。结论经腹腔镜预防性宫颈环扎术患者的围产结局与经阴道预防性宫颈环扎术相似,但孕中晚期并发症发生率高于后者。预防性宫颈环扎术后患者是否发生早产与感染相关,而与手术前后宫颈长度及宫颈内口无关。Objective To investigate later complications and perinatal outcomes after trans-laparoscope prophylactic cervical cerclage. Method From January 2012 to January 2017 in Fuxing Hospital Affiliated to Capital Medical University,36 patients who have performed trans-laparoscope prophylactic cervical cerclage in Department of the Center of Hysteroscope was selected as study group (LTCC),36 patients who have performed the trans-vagina prophylactic cervical cerclage in Department of Gynecology with similar age,pre-pregnant BMI were matched as the control group (VTCC).All subjects performed regular antenatal care and delivered in Department of the Obstetrics.Then we compared the later complications and perinatal outcomes after the two different prophylactic cervical cerclage.Result There are more times of miscarriage during second trimester in study group than that of control group[(2.12±1.17)vs (1.15±1.18)], and cervical length of study group was shorter than that of control group[(25.34±3.88)mm vs (28.15±5.73)mm],the difference was significant(P<0.05).The prevalence of abdominal pain and hospitalize during later pregnancy of study group was much higher than that of control group (38.2% vs 14.7% and 41.2% vs 17.6%),and the period of usage of progesterone was longer in study group than control group[(28.34±2.78)weeks vs (3.68±2.63)weeks],the difference was significant(P<0.05).There were no significant difference between the two groups in cervical length and the incidence of genital tract infection during pregnancy.There was no difference in perinatal outcomes such as the rate of preterm birth and postpartum hemorrhage delivery week and neonatal birth weight between the two groups. Comparing with control group,patients in study group had higher incidence of adhesion (35.3% vs 0),lower premature rupture of fetal membranes rate (11.8% vs 38.2%)and lower the proved infection rate by histology (6.7% vs 25.9%),the difference was significant(P< 0.05).Significant difference can be seen in the incidence of premature rupture

关 键 词：经腹腔镜预防性宫颈环扎术 晚期手术并发症 围产结局 

分 类 号：R71[医药卫生—妇产科学]