紧急宫颈环扎术中使用单道或双道缝线预防早产的效果  

Comparison of one stitch vs two stitches for emergency cervical cerclage to prevent preterm birth in singleton pregnancies

作　　者：许志敏 张钧 刘静 张琳 潘勉[1] Xu Zhimin;Zhang Jun;Liu Jing;Zhang Lin;Pan Mian(Department of Obstetrics and Gynecology,Fujian Maternity and Child Health Hospital(Clinical Medicine College of Obstetrics&Gynecology and Pediatrics,Fujian Medical University),Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院(福建医科大学妇儿临床医学院)妇产科,福州350001

出　　处：《中华围产医学杂志》2023年第10期818-825,共8页Chinese Journal of Perinatal Medicine

基　　金：福建省自然科学基金(2021J01406,2022J011034);福建省科技创新联合资金(2020Y9148,2021Y9175)。

摘　　要：目的比较单道缝线与双道缝线施行紧急经阴道宫颈环扎术对宫颈机能不全孕妇临床预后的影响。方法回顾性选取2018年1月至2022年12月在福建省妇幼保健院行紧急经阴道宫颈环扎术的38例宫颈机能不全的单胎妊娠孕妇。根据宫颈环扎术缝线数目的不同分为单道缝线组(在宫颈阴道交界水平做环形连续缝合并打结,n=19)和双道缝线组[第一道环扎线缝合方式同单道缝线组,在第一道缝线的下方近宫颈外口处再次行环形缝合(第二道缝线)以闭合宫颈外口,n=19],采用两独立样本t或t’’检验、秩和检验、χ2检验或Fisher精确概率法比较组间围产结局的差异,采用Kaplan-Meier生存分析评估缝线数目延长宫颈环扎术后孕周的效能。结果双道缝线组环扎时孕周与单道缝线组相比差异无统计学意义[24.9周(23.9~25.9周)与23.6周(22.6~24.9周),Z=-1.61,P=0.108]。双道缝线组平均分娩孕周[(33.1±4.8)与(28.6±4.3)周,t=-3.10]和宫颈环扎术后延长孕周[(8.5±4.6)与(5.0±2.6)周,t=-2.90]均大于单道缝线组,且<32周(6/19与16/19,χ2=10.80)、<34周(8/19与17/19,χ2=9.47)和<37周(14/19与19/19,Fisher精确概率法)的累计早产率均低于单道缝线组(P值均<0.05)。Kaplan-Meier生存分析显示双道缝线组延长妊娠孕周的效能优于单道缝线组[log-rank testχ2(1)=13.10,P<0.05]。虽然双道缝线组与单道缝线组新生儿病死率差异无统计学意义(2/19与4/19,Fisher精确概率法,P=0.660),但双道缝线组存活新生儿的出生体重[2370.0 g(1775.0~2710.0 g)与1300.0 g(1210.0~1660.0 g),Z=-3.14]、新生儿重症监护病房入住率(9/17与15/15,Fisher精确概率法)以及Ⅲ期坏死性小肠结肠炎(0/17与5/15,Fisher精确概率法)、中~重度呼吸窘迫综合征(5/17与10/15,χ2=4.44)和Ⅲ~Ⅳ级脑室内出血发生率(0/17与7/15,Fisher精确概率法)均低于单道缝线组(P值均<0.05)。结论与单道缝线相比,使用双道缝线实施紧急经阴道宫颈环扎Objective To compare the effect of two vs one stitch on outcomes in women with cervical incompetence who undergo emergency transvaginal cervical cerclage.Methods A retrospective study was conducted on 38 cases of cervical incompetence patients who underwent emergency cervical cerclage at Fujian Maternity and Child Health Hospital from January 2018 to December 2022.These subjects were divided into two groups:one stitch group(loop continuous suture and knot at cervical-vaginal junction level)and two stitches group(the first loop was closed with a single suture set,and the second loop was closed below the first loop near the cervical outlet)with 19 cases in each group.Two independent samples t or t'-test,rank-sum test,Chi-square test and Fisher's exact test were used to compare the differences in perinatal outcomes between the two groups.Kaplan-Meier survival analysis was performed to evaluate the efficacy of the prolongation of gestational age after emergency transvaginal cervical cerclage.Results There was no statistically significant difference in the gestational age at cervical cerclage between the two stitches and the one stitch group[24.9 weeks(23.9-25.9 weeks)vs 23.6 weeks(22.6-24.9 weeks),Z=-1.61,P=0.108].The average gestational age at delivery[(33.1±4.8)vs(28.6±4.3)weeks,t=-3.10]and the prolongation of gestational age after cerclage[(8.5±4.6)vs(5.0±2.6)weeks,t=-2.90]were significantly greater in the two stitches group compared to those in the one stitch group,while the rates of preterm birth before 32 weeks(6/19 vs 16/19,χ2=10.80),34 weeks(8/19 vs 17/19,χ2=9.47),and 37 weeks(14/19 vs 19/19,Fisher's exact test)were lower(all P<0.05).The Kaplan-Meier survival analysis demonstrated that the two stitches group had significantly higher efficacy in prolonging gestational age compared to the one stitch group[log-rank testχ2(1)=13.10,P<0.05].Although there was no statistically significant difference in the neonatal mortality between the two groups(2/19 vs 4/19,Fisher's exact test,P=0.660),survival neonates i

关 键 词：环扎术 宫颈 早产 缝线 预后 

分 类 号：R713.4[医药卫生—妇产科学] R714.21[医药卫生—临床医学]