Shirodkar和McDonald宫颈环扎术治疗双胎早产高危孕妇的效果研究  

Pregnancy outcome of Shirodkar and McDonald cervical cerclage in the treatment of high-risk pregnant women with twin premature delivery

作　　者：苏彦梓 李联 庞妮 SU Yan-zi;LI Lian;PANG Ni(Department of Obstetrics and Gynecology,Xi'an Angel Maternity Hospital,Xi'an 710077,Shaanxi,CHINA;Department of Obstetrics and Gynecology,Xi'an Fengcheng Hospital,Xi'an 710000,Shaanxi,CHINA;Department of Obstetrics and Gynecology,Chang'an Hospital,Xi'an 710000,Shaanxi,CHINA)

机构地区：[1]西安安琪儿妇产医院妇产科,陕西西安710077 [2]西安凤城医院妇产科,陕西西安710000 [3]长安医院妇产科,陕西西安710000

出　　处：《海南医学》2023年第24期3578-3582,共5页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:20199348)。

摘　　要：目的比较Shirodkar和McDonald宫颈环扎术治疗双胎早产高危孕妇的妊娠结局。方法回顾性分析2020年5月至2022年6月西安安琪儿妇产医院收治的134例双胎早产高危孕妇的临床资料,按照孕妇宫颈位置高低情况行不同手术,其中67例给予McDonald宫颈环扎术治疗者纳入对照组,67例给予Shirodkar宫颈环扎术治疗者纳入观察组。比较两组孕妇的手术时间、住院时间和术中出血量、术后延长妊娠孕周、终止妊娠孕周和孕周≥34周分娩情况以及术后流产、早产、足月产、新生儿存活率、新生儿体质量、5 min新生儿Apgar评分情况。结果两组孕妇的手术时间、住院时间及术中出血量比较差异均无统计学意义(P>0.05);术后,观察组孕妇延长妊娠孕周、终止妊娠孕周分别为(22.32±1.86)周、(38.40±1.82)周,明显长于对照组的(18.52±1.91)周、(34.83±1.34)周,孕周≥34周分娩率为94.03%,明显高于对照组的77.61%,手术失败率和手术感染率分别为1.49%、2.99%,明显低于对照组的10.45%、11.94%,差异均有统计学意义(P<0.05);术后,观察组孕妇的流产、早产率分别为2.99%、13.43%,明显低于对照组的14.93%、28.36%,而足月产和新生儿存活率分别86.57%、95.52%,明显高于对照组的52.24%、85.07%,新生儿体质量、5 min新生儿Apgar评分分别为(3.93±0.75)kg、(9.16±0.41)分,也明显高于对照组的(3.01±0.28)kg、(7.38±0.37)分,差异均有统计学意义(P<0.05)。结论Shirodkar宫颈环扎术与McDonald宫颈环扎术治疗双胎早产高危孕妇的手术时间、住院时间及术中出血量相当,但Shirodkar宫颈环扎术能有效延长妊娠孕周,提高新生儿存活率,改善妊娠结局。Objective To compare the pregnancy outcomes of Shirodkar and McDonald cervical cerclage in the treatment of high-risk pregnant women with twin premature delivery.Methods The clinical data of 134 patients with single fetal cervical incompetence admitted to Xi'an Angel Maternity Hospital from May 2020 to June 2022 were retrospectively analyzed.According to the height of the patient's cervix,different surgeries were performed:67 patients who received McDonald cervical cerclage treatment were included in the control group,while 67 patients who received Shirodkar cervical cerclage treatment were included in the observation group.The operation time,length of hospital stay,intraoperative blood loss,gestational age of prolonged pregnancy,gestational age of termination of pregnancy,and delivery condition of gestational age≥34 weeks after operation,as well as abortion,preterm birth,term birth,and neonatal survival rate,neonatal weight,Apgar score of 5 min newborn after operation were compared between the two groups.Results There was no statistically significant difference in surgical time,length of hospital stay,and intraoperative bleeding between the two groups(P>0.05).After operation,the gestational weeks of prolonged pregnancy and termination of pregnancy in the observation group were(22.32±1.86)weeks and(38.40±1.82)weeks,which were significantly longer than(18.52±1.91)weeks and(34.83±1.34)weeks in the control group;the delivery rate of gestational age≥34 weeks was 94.03%,which was significantly higher than 77.61%of the control group;the surgical failure rate and surgical infection rate were 1.49%and 2.99%,which were significantly lower than 10.45%and 11.94%of the control group;the differences were statistically significant(P<0.05).After surgery,the rates of miscarriage and premature birth in the observation group were 2.99%and 13.43%,which were significantly lower than 14.93%and 28.36%in the control group,while the rate of full term delivery and the survival rate of newborns were 86.57%and 95.52%,which were sig

关 键 词：Shirodkar宫颈环扎术 McDonald宫颈环扎术 早产高危孕妇 宫颈机能不全 孕期 临床疗效 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]