不同妊娠期经阴道子宫颈环扎术后妊娠结局分析  

Analysis of pregnancy outcome of different transvaginal cervical cerclage

作　　者：杨京晶[1] 梁梅英[1] YANG Jingjing;LIANG Meiying(Department of Obstetrics and Gynecology,Peking University People’s Hospital,Beijing100044,China)

机构地区：[1]北京大学人民医院妇产科,100044

出　　处：《中国妇产科临床杂志》2022年第2期164-166,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨妊娠期不同经阴道宫颈环扎手术方式患者母儿结局及相关因素。方法选取2013年1月至2021年9月就诊于北京大学人民医院产科因妊娠期宫颈机能不全行宫颈环扎术的69例患者,其中行Shirodkar宫颈环扎手术37例作为研究组;行McDonald宫颈环扎手术32例作为对照组。比较两组的临床特点及妊娠结局差异。结果研究组与对照组比较,妊娠期体质量增加较大[(12.66±6.00)kg/m^(2),(9.21±5.79)kg/m^(2);P=0.022]、手术时间长[47 min(41~60 min),20.5 min(17~37.5 min);P<0.001]、拆线孕周晚[36.71周(36.14~37周),34.43周(24.32~36.75周),P=0.003],分娩孕周大[38.9周(36.3~39.8周),35.0周(30.1~39.0周),P=0.005],妊娠≥28周(91.9%,68.8%,P=0.028)、≥34周(81.1%,59.4%,P=0.036)、≥37周(67.6%,37.5%,P=0.016)分娩的发生率更高,计划分娩的比例高(43.2%,12.5%,P=0.006),环扎失败率低(8.1%,31.3%,P=0.028)。两组早产因素的多变量回归分析提示,Shirodkar宫颈环扎是降低早产发生率的保护因素(OR=0.063,95%CI:0.008~0.492,P=0.008)。结论Shirodkar宫颈环扎在降低宫颈环扎术后早产方面优于McDonald宫颈环扎术。Objective To investigate the differences in pregnancy outcomes between the different transvaginal cervical cerclage.Methods This retrospective study included pregnant women with cervical insufficiency admitted to Peking University People’s Hospital between January 2013 and September 2021.There were 37 patients in the study group underwent Shirodkar’s cerclage,and 32 patients in the control group underwent McDonald’s cerclage.The pregnancy outcomes were compared.Results Compared with the control group,the study group showed more weight gain during pregnancy[(12.66±6.00)kg/m^(2),(9.21±5.79)kg/m^(2);P=0.022],long operation time[45 min(40-51.3 min)vs.20.5 min(17.3-25.0),P<0.001]and later cerclage removal[36.71(36.14-37)vs.34.43(24.32-36.75),P=0.003].Gestational weeks at delivery in the Shirodkar group were more advanced than in the McDonald group[38.9(36.3-39.8)vs.35.0(30.1-39.0),P=0.005].Compared with the McDonald group,the Shirodkar group had higher incidences of deliveries≥28 gestational weeks(91.9%vs.68.8%,P=0.027),deliveries≥34 gestational weeks(81.1%vs.59.4%,P=0.037),deliveries≥37 gestational weeks(67.6%vs.37.5%,P<0.001),induced labor(43.2%vs.12.5%,P=0.006),and fewer fetal loss(8.1%vs.31.3%,P=0.017).Multivariate regression analysis of preterm birth factors showed that Shirodkar cervical cerclage was a protective factor to reduce the incidence of preterm birth(OR=0.063,95%CI:0.008,0.492,P=0.008).Conclusion Shirodkar cerclage appears to have advantages over McDonald cerclage in preventing fetal loss and a fewer frequency of preterm deliveries.

关 键 词：宫颈机能不全 宫颈环扎 Shirodkar环扎 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]