经阴道宫颈环扎术——MacDonald术式应用于双胎妊娠的妊娠结局分析  

Analysis of the Pregnant Outcomes of Transvaginal Cervical Cerclage——MacDonald Operation in Twin Pregnancy

作　　者：刘建华 王玉贤 赵惠玲 郗晓丽 LIU Jian-hua;WANG Yu-xian;ZHAO Hui-ling;XI Xiao-li(Shanxi Medical University,Taiyuan 030000,China;The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Taiyuan Maternal and Child Health Hospital,Taiyuan 030012,China)

机构地区：[1]山西医科大学,太原030000 [2]山西医科大学第一医院 [3]太原市妇幼保健院

出　　处：《国际生殖健康／计划生育杂志》2020年第4期280-283,共4页Journal of International Reproductive Health/Family Planning

摘　　要：目的:探讨双胎妊娠合并宫颈机能不全孕妇行经阴道宫颈环扎术——MacDonald术式治疗的妊娠结局。方法:选择2014年1月—2019年6月于山西医科大学第一医院规律产检且分娩的双胎妊娠合并宫颈机能不全的孕妇97例。根据其病史诊疗经过及随访结果分为2组,手术组为宫颈环扎者(n=57),保守组为卧床休息且行药物对症治疗者(n=40);再根据不同手术时机将手术组分为预防性环扎组(n=39)和紧急性环扎组(n=18)。分析比较其母婴结局及临床效果。结果:手术组的延长孕周和分娩孕周均高于保守组,差异有统计学意义(P<0.05)。预防性环扎组的环扎前宫颈长度、延长孕周、分娩孕周、新生儿出生体质量均高于紧急性环扎组(P<0.05);预防性环扎组的环扎孕周低于紧急性环扎组(P<0.05)。手术组<35周早产率、≥35周分娩率和活产率均高于保守组(P<0.05);保守组流产率高于手术组(P<0.05)。预防性环扎组流产率和<35周早产率与紧急性环扎组相比较,差异无统计学意义(P>0.05);但预防性环扎组≥35周分娩率和活产率均高于紧急环扎组,差异均有统计学意义(P<0.05)。结论:相对于保守治疗,双胎妊娠合并宫颈机能不全的孕妇行经阴道宫颈环扎术,对改善妊娠结局有积极的意义;且选择合适的手术时机有利于延长孕周。Objective: To explore the application of transvaginal cervical cerclage-MacDonald operation in those women with twin pregnancy combined with cervical insufficiency, and follow-up visit the pregnancy outcomes. Methods:Ninety-seven women with twin pregnancy combined with cervical dysfunction who had a regular pregnancy test were included from January 2014 to June 2019. According to their medical history and follow-up results, they were divided into 2 groups. The surgical group(n=57) was treated by cervical cerclage, and the conservative group(n=40) was treated by bed-rest and symptomatic drug. Then according to different surgical timing, the surgical group was divided into 2 subgroups: the preventive cerclage subgroup(n =39) and the emergency cerclage subgroup(n=18). The mother-infant outcomes and clinical effects were compared. Results:The prolonged gestational age and delivery gestational age of the operation group were significantly higher than those of the conservative group(P<0.05). The length of cervical before ligation, prolonged gestation week, weeks of delivery, and birth weight of newborns in the preventive cerclage subgroup were higher than those in the emergency cerclage subgroup(P<0.05). The gestational age of circumcision in the preventive cerclage subgroup was lower than that in the emergency cerclage subgroup(P<0.05). The operation group′s preterm birth rate <35 weeks, ≥35 weeks delivery rate and live birth rate were higher than the conservative group(P <0.05). The conservative group had a higher abortion rate than the surgical group(P <0.05). Compared with the emergency ligation group, the miscarriage rate and preterm birth rate in the preventive cerclage group were not statistically significant(P>0.05). However, the preventive cerclage group had a higher delivery rate and live birth rate at 35 weeks. In the emergency circumcision group, the differences were statistically significant(P<0.05). Conclusions:Compared with conservative treatment, the transvaginal cervical cerclage for pregnant women

关 键 词：宫颈功能不全 妊娠 双胎 环扎术 宫颈 妊娠结局 治疗 

分 类 号：R714.23[医药卫生—妇产科学]