孕前环扎在宫颈功能不全治疗中的临床应用价值  

The clinical value of pre-pregnancy cervicalcerclage in the treatment of cervical incompetence

作　　者：李全香[1] 杨娜[1] 严凤[1] 

机构地区：[1]河北省保定市妇幼保健院妇一科,保定071000

出　　处：《陕西医学杂志》2017年第7期912-915,共4页Shaanxi Medical Journal

基　　金：河北省保定市科学技术研究与发展指导计划项目(16ZF002)

摘　　要：目的:分析孕期和孕前宫颈环扎术后的妊娠结局,探讨孕前环扎的疗效。方法:收集宫颈功能不全患者170例,其中86例于孕15~20周行Mc Donald法环扎(A组),40例经阴道孕前环扎(B组),44例腹腔镜下孕前环扎(C组)。结果:三组环扎术后妊娠期宫颈长度、孕周延长时间、围产儿体质量相比,A组低于B组、B组低于C组[(3.08±0.47)cm与(3.75±0.63)cm与(4.21±0.86)cm;(82.87±7.1)d与(98.9±5.37)d与(116.81±6.68)d;(2448.66±325.15)g与(2833.03±420.59)g与(3213.72±570.53)g],差异均有统计学意义(P均<0.05)。难免流产、早产发生率相比,A组高于B组、B组高于C组[18.7%与12.5%与4.5%;48.8%与37.5%与22.7%],足月产率、围产儿存活率相比,A组低于B组、B组低于C组[32.5%与50.0%与72.8%;60.47%与82.50%与97.73%],差异均有统计学意义(P均<0.05)。结论:孕前环扎治疗宫颈功能不全安全有效,能够提高手术成功率,改善围生结局,对于宫颈小于3.0cm或既往孕期环扎失败者,疗效更好。Objective：To analysis of the pregnancy outcome of pregnancy and pre-pregnancy cervical cerclage, discuss the curative effect of pre-pregnancy cerclage.Methods：170 patients with cervical insufficiency were collected.There were 86 cases in 15-20 weeks of gestation for polypropylene McDonald encircling band cerclage（A group）, 40 cases with a suture underwent transvaginal cervical cerclage pre-pregnancy （B group）, 44 cases with polypropylene encircling band laparoscopic pregnancy cervical cerclage（C group）.Results： Three groups of patients with pregnancy cervical length after ligation, prolonged pregnant time, perinatal weight, A group was lower than that of B group, B group was lower than that of C group [（3.08±0.47） cm vs （3.75±0.63） cm vs （4.21±0.86） cm;（82.87±7.1）d vs （98.9±5.37）d vs （116.81±6.68）d;（2448.66±325.15）g vs （2833.03±420.59）g vs （3213.72±570.53）g], the difference was statistically significant （P〈0.05）.The incidence of inevitable abortion and premature delivery, A group was higher than that of B group, B group was higher than that of C group （18.7% vs 12.5% vs 4.5%;48.8% vs 37.5% vs 22.7%）, Comparison of term birth rate and perinatal survival rate, A group was lower than that of B group, B group was lower than that of C group（32.5% vs 50.0% vs 72.8%;60.47% vs 82.50% vs 97.73%）, the difference was statistically significant （P〈0.05）.Conclusion： Pre-pregnancy cervical cerclage for cervical incompetence is safe and effective, Can improve the success rate of operation,improve perinatal outcomes, especially for the cervical cerclage is less than 3.0 cm or previous pregnancy failure of cervical insufficiency patients can benefit from surgery.

关 键 词：子宫颈功能不全/治疗 环扎术 宫颈 妊娠结局 

分 类 号：R714.4[医药卫生—妇产科学]