子宫颈缩短的双胎输血综合征患者胎儿镜术中同时行子宫颈环扎术对妊娠结局的影响  

Effect of cervical cerclage during fetoscopic laser surgery on the pregnancy outcome of patients with twin-twin transfusion syndrome combined with short cervix

作　　者：刘嘉欣 尹少尉[1] 刘彩霞[1] 彭羽 孟伊琳 LIU Jia-xin;YIN Shao-wei;LIU Cai-xia;PENG Yu;MENG Yi-lin(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical Uuniversity,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院妇产科中国医科大学出生队列中心辽宁省母胎医学重点实验室,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2021年第2期215-218,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2018YFC1002902);中国医科大学2019年度医疗新技术新项目(112-3111190311)。

摘　　要：目的探讨胎儿镜术中同时行子宫颈环扎术对于治疗子宫颈长度缩短的双胎输血综合征(TTTS)患者妊娠结局的影响。方法采用回顾性研究,将2016年6月至2018年12月中国医科大学附属盛京医院收治的61例子宫颈长度≤20mm并接受胎儿镜激光手术(FLS)治疗的TTTS患者作为研究对象,将研究对象分为两组:环扎组(n=38)及未行环扎术组(n=23),探讨子宫颈环扎术对行胎儿镜激光治疗子宫颈缩短的TTTS患者妊娠结局的影响。结果环扎组和未行环扎组的分娩孕周分别为(32.20±4.43)周、(29.09±4.78)周(P=0.013),术后继续妊娠时间分别为(64.82±41.70)d、(36.17±28.00)d(P=0.002),双胎至少一胎生存率分别为92.1%和69.6%(P=0.032),双胎生存率分别为78.9%和39.1%(P=0.03),早产胎膜早破(PPROM)发生率分别为18.4%和43.5%(P=0.044)。结论胎儿镜术中同时行子宫颈环扎术,对于子宫颈长度≤20mm伴有或不伴有子宫颈形态改变的TTTS患者,可延长分娩孕周及术后继续妊娠时间、改善妊娠结局,具有较高的临床应用价值。Objective To describe the effect of cervical cerclage during fetoscopic laser surgery(FLS) on the pregnancy outcome of patients with twin-twin transfusion syndrome(TTTS) combined with short cervix.Methods This study is a retrospective study.From June 2016 to December 2018,61 patients with TTTS and cervix length ≤20 mm were included as subjects,who had endergone FLS successfully in Shengjing Hospital of China Medical Uuniversity.The study subjects were divided into 2 groups:cervical cerclage group(n=38)and no-cervical cerclage group(n=23).The effect of cervical cerclage on the pregnancy outcome of patients with TTTS and short cervical who had undergone FLS was explored.Results The median gestational age at delivery in the cerclage group and the no-cervical cerclage group was(32.20±4.43) weeks and(29.09±4.78) weeks(P=0.013),and the median interval between surgery and delivery was(64.82±41.70)days and(36.17±28.00)days(P=0.002).The survival of rate at least one twin was 92.1% and 69.6%(P=0.032),and the survival rate of twins was 78.9% and 39.1%(P=0.03).The incidence rates of premature rupture of the membranes(PPROM)were 18.4% and 43.5%(P=0.044).Conclusion Cervical cerclage during fetoscopic laser surgery(FLS) in the treatment of twin-twin transfusion syndrome(TTTS)combined with short cervix with or without changes in cervical morphology can prolong the gestational weeks at delivery and the interval between surgery and delivery,and improve pregnancy outcomes which is of great clincal application value.

关 键 词：双胎输血综合征 胎儿镜激光手术 子宫颈环扎术 子宫颈缩短 

分 类 号：K714.23[历史地理—世界史]