子宫颈机能不全合并中重度宫腔粘连的处理  

Management of cervical incompetence combined with moderate to severe intrauterine adhesions

作　　者：李芳 江杭 李外星 李月燃[1] 潘琼[1] 杨益民[1] 徐大宝[1] LI Fang;JIANG Hang;LI Wai-xing;LI Yue-ran;PAN Qiong;YANG Yi-min;XU Da-bao(Department of Obstetrics and Gynecology,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院妇产科,湖南长沙410013

出　　处：《中国实用妇科与产科杂志》2021年第1期96-99,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81671492)。

摘　　要：目的探讨子宫颈机能不全合并中重度宫腔粘连患者的诊断和治疗经验。方法回顾性分析2017年9月至2019年12月在中南大学湘雅三医院诊治的11例子宫颈机能不全合并中、重度宫腔粘连患者的诊断和治疗的相关资料,并随访治疗后的妊娠结局。结果11例患者术前均有典型的中孕期无痛性子宫颈扩张病史,其中7例宫腔镜术前子宫颈内口可无阻力通过7号扩宫棒,但另4例因子宫颈管和宫腔下段粘连无法置入扩宫棒,而在宫腔粘连松解术后3个月复查宫腔镜前用7号宫颈扩张器无阻力通过子宫颈内口进一步明确诊断。宫腔粘连及孕前经腹腔镜子宫颈环扎术后妊娠率63.6%(7/11),6例已分娩,活产率100%,另1例现孕11周,无不适。结论子宫颈机能不全合并宫腔下段或子宫颈管粘连时,需先分离粘连后再用7号扩宫棒评估子宫颈而进一步明确诊断;子宫颈机能不全合并中重度宫腔粘连患者行孕前腹腔镜子宫颈环扎的预后较好。Objective To explore the experience in diagnosis and treatment of cervical incompetence combined with moderate to severe intrauterine adhesions.Methods Totally 11 patients with cervical incompetence combined with moderate to severe intrauterine adhesions were diagnosed,treated and followed up at the Third Xiangya Hospital of Central South University from September 2017 to December 2019,and their medical records and the pregnancy outcomes were retrospectively analyzed.Results All patients had a history of typical painless cervical dilatation during the second trimester before surgery.In 7 patients,the No.7 Hegar dilator was able to pass through the inner orifice of the cervix before surgery without resistance.In the other 4 patients,the Hegar dilator could not be inserted before surgery due to the adhesions of the cervical canal and the lower uterine segment;the diagnoses of these patients were further confirmed at 3 months after hysteroscopic adhesiolysis when the No.7 Hegar dilator was able to pass through the inner orifice of the cervix without resistance.The pregnancy rate was 63.6%(7/11),6 had delivered,the live birth rate was100%,and another one was 11 weeks pregnant now with no discomfort.Conclusion In patients with cervical incompetence combined with cervical or lower segment intrauterine adhesions,it is necessary to separate the adhesion prior to evaluating the cervical competency with the No.7 Hegar dilator to confirm the diagnosis.Pre-pregnancy laparoscopic cervical cerclage has a good prognosis in patients with cervical incompetence complicated by moderate to severe intrauterine adhesions.

关 键 词：子宫颈机能不全 宫腔粘连 经腹腔镜子宫颈环扎 诊断 活产率 

分 类 号：R713.4[医药卫生—妇产科学]