双胎妊娠紧急子宫颈环扎术妊娠结局的研究  

A Retrospective Study on Pregnancy Outcome of Emergency Cervical Cerclage in Twin Pregnancy

作　　者：孙笑[1] 时春艳[1] 梁建芳[2] 张梦莹[1] 玛丽帕提·马尔旦 杨慧霞[1] SUN Xiao;SHI Chunyan;LIANG Jianfang(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,People′s Hospital of Hejian City,Hejian Hebei 062450,China)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]河间市人民医院妇产科,河北河间062450

出　　处：《实用妇产科杂志》2023年第8期616-620,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨双胎妊娠紧急子宫颈环扎术(CC)的临床疗效。方法:收集2004年1月至2021年12月于北京大学第一医院就诊并分娩的双胎妊娠孕16~27^(+6)周宫口开大1~4 cm行紧急CC的30例孕妇的临床资料,依据CC的孕周分为<24周组(19例)和≥24周组(11例)。比较两组的CC疗效,以是否获得活产儿分为成功组(23例)和失败组(7例),分析影响CC分娩结局的相关因素。结果:①30例双胎妊娠紧急CC后的分娩孕周29.5±5.2周,围产儿死亡率25.0%,延长孕周6.8±4.4周。②孕周≥24周组孕妇的CC孕周(24.7±0.8周vs.21.7±1.6周)、分娩孕周(31.6±2.8周vs.28.3±6.0周)及活产率(100.0%vs.63.2%)明显高于<24周组,差异有统计学意义(P<0.05)。③多因素Logistics回归分析示,术前超声检查宫腔内絮状回声、术后白细胞计数(WBC)≥10×10^(9)/L是双胎妊娠紧急CC失败的独立危险因素(OR>1,P<0.05),CC孕周≥24周是保护性因素(OR<1,P<0.05)。结论:双胎妊娠孕周≥24周后行紧急CC仍有临床价值,必要时双胎妊娠行紧急CC可以在孕24~27^(+)周进行。CC孕周<24周、术前超声检查提示宫腔内絮状回声、术后WBC≥10×10^(9)/L者双胎妊娠紧急CC失败的风险升高。Objective:To investigate the clinical effect of emergency cervical cerclage(CC)in twin pregnancy.Methods:From January 2004 to December 2021,a total of 30 pregnant women who underwent emergency cervical cerclage in our hospital with the uterine opening 1-4 cm at 16-27^(+6)weeks′gestation were collected.According to gestational age,the group was divided into<24 weeks(19 cases)and≥24 weeks(11 cases).The effects of the two groups were compared,and the influencing factors between the successful(23 cases)and failed groups(7 cases)were analyzed.Results:①The mean gestational age of patients after emergency CC was 29.5±5.2 weeks,the perinatal mortality was 25.0%,and the prolonged gestational age was 6.8±4.4 weeks.②The gestational age(24.7±0.8 weeks vs.21.7±1.6 weeks),delivery gestational age(31.6±2.8 weeks vs.28.3±6.0 weeks),and live birth rate(100.0%vs.63.2%)in≥24 weeks group were significantly higher than those in<24 weeks group(P<0.05).③Multi-factor analysis showed that preoperative intrauterine sludge and postoperative conventional white blood cells≥10×10^(9)/L were independent risk factors for the failure of emergency CC in twin pregnancy(OR>1,P<0.05),however,gestational age≥24 weeks of pregnancy was a protective factor(OR<1,P<0.05).Conclusions:There is still clinical value of emergency CC in twin pregnancy more than 24 weeks′gestation.If necessary,emergency CC in twin pregnancy can be performed at 24-27^(+)weeks′gestation.The gestational age<24 weeks,preoperative intrauterine sludge,and routine white blood cells≥10×10^(9)/L after surgery reduced the success rate of emergency CC in twin pregnancy.

关 键 词：双胎妊娠 紧急子宫颈环扎术 子宫颈外口开大 子宫颈环扎术孕周 

分 类 号：R714.23[医药卫生—妇产科学]