妊娠期改良Shirodkar经阴道子宫颈环扎术治疗子宫颈机能不全的临床研究  

Clinical study of modified Shirodkar transvaginal cervical cerclage during pregnancy in the treatment of cervical insufficiency

作　　者：宋梅英[1] 王夫川 李晓雨 刘玉环[1] Song Meiying;Wang Fuchuan;Li Xiaoyu;Liu Yuhuan(Department of Gynecology,Fu Xing Hospital,Capital Medical University,Beijing 100045,China;Department of Obstetrics and Gynecology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属复兴医院妇科,北京100045 [2]首都医科大学附属北京地坛医院妇产科,北京100015

出　　处：《中华妇产科杂志》2023年第11期811-817,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨妊娠期改良Shirodkar经阴道子宫颈环扎术(TVCC)治疗子宫颈机能不全(CI)的临床疗效及其对妊娠结局的影响。方法回顾性分析2015年1月1日至2021年8月31日首都医科大学附属复兴医院收治的218例CI孕妇的临床资料,根据手术途径不同分为妊娠期行改良Shirodkar TVCC治疗(TVCC组,108例)和非妊娠期行腹腔镜子宫颈环扎术(LACC)治疗(LACC组,110例),对两组孕妇的临床资料和妊娠结局进行比较。进一步根据子宫颈长度(CL)对两组孕妇进行分层研究,探讨两种术式对不同CL的CI孕妇妊娠结局的影响。结果(1)环扎术前、术中相关指标:两组孕妇在环扎手术过程中均未发生大出血、膀胱损伤、麻醉意外等并发症。与LACC组相比,TVCC组孕妇的术前CL较长[分别为(2.3±0.6)、(2.7±0.6)cm]、术中出血量较多[分别为(7.5±0.5)、(14.4±1.4)ml]、住院时间更长[分别为(6.0±0.1)、(7.3±0.4)d],但手术时间更短[分别为(42.9±1.6)、(25.9±1.4)min]、住院费用更少[分别为(9912±120)、(5598±140)元],分别比较,差异均有统计学意义(P均<0.05)。(2)环扎术后妊娠结局:TVCC组与LACC组的活产率分别为95.4%(103/108)、96.4%(106/110),两组比较,差异无统计学意义(χ2=2.211,P=0.232)。TVCC组的早产率(12.0%,13/108)高于LACC组(7.3%,8/110),新生儿出生体重低于LACC组[分别为(3006±96)、(3225±42)g],低出生体重儿占比高于LACC组[分别为15.5%(16/103)、1.9%(2/106)],两组分别比较,差异均有统计学意义(P均<0.05)。(3)不同CL的分层分析:对于CL<2.0 cm的孕妇,TVCC组的流产率高于LACC组(分别为2/9、3.0%),活产率低于LACC组(分别为7/9、97.0%),分别比较,差异均有统计学意义(P均<0.05)。对于CL为2.0~<2.5 cm、2.5~<3.0 cm、CL≥3.0 cm的CI孕妇,两组孕妇的早产率、活产率分别比较,差异均无统计学意义(P均>0.05)。结论改良Shirodkar TVCC操作简单易行,较LACC显著降低了剖宫产率、医疗费用,且活产率无显著差�Objective To investigate the clinical efficacy of modified Shirodkar transvaginal cervical cerclage(TVCC)in the treatment of cervical insufficiency(CI)and its impact on maternal and fetal outcomes.Methods The clinical data of 218 pregnant women with CI admitted to Fu Xing Hospital,Capital Medical University from January 1,2015 to August 31,2021 was retrospectively analyzed.According to different surgical approaches,they were divided into modified Shirodkar TVCC treatment during pregnancy(TVCC group,108 cases)and non-pregnant women underwent laparoscopic cervical cerclage(LACC)treatment(LACC group,110 cases).The clinical data and pregnancy outcomes of the two groups were compared.Furthermore,the two groups of pregnant women were stratified according to cervical length(CL)to explore the effects of the two surgical methods on the pregnancy outcomes of CI women with different CL.Results(1)Related indicators before and during cerclage:there were no complications such as massive hemorrhage,bladder injury and anesthesia accident in the two groups of pregnant women during cerclage.Compared with the LACC group,TVCC group had longer preoperative CL[(2.3±0.6)vs(2.7±0.6)cm],more intraoperative blood loss[(7.5±0.5)vs(14.4±1.4)ml]and longer hospital stay[(6.0±0.1)vs(7.3±0.4)day].However,the operation time was shorter[(42.9±1.6)vs(25.9±1.4)minute]and the hospitalization cost was less[(9912±120)vs(5598±140)yuan],and the differences were statistically significant(all P<0.05).(2)Pregnancy outcomes:live birth rates were 95.4%(103/108)in the TVCC group and 96.4%(106/110)in the LACC group,showing no significant difference between the two groups(χ2=2.211,P=0.232).The preterm birth rate(12.0%,13/108)in the TVCC group was higher than that in the LACC group(7.3%,8/110),the neonatal birth weight was lower than that in the LACC group[(3006±96)vs(3225±42)g],and the proportion of low birth weight infants was higher than that in the LACC group[15.5%(16/103)vs 1.9%(2/106)],and the differences were statistically significant(all P<0

关 键 词：宫颈功能不全 环扎术 宫颈 早产 腹腔镜检查 治疗结果 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]