宫颈锥切术后经阴道宫颈峡部环扎术治疗宫颈机能不全不同手术时机对妊娠结局的影响  

Clinical efficacy of surgical timing of the transvaginal cervical isthmus cerclage in the patients with cervical incompetence after cervical conization

作　　者：曹翠萍 尉敏龄[1] 张松英[1] CAO Cui-ping;WEI Min-ling;ZHANG Song-ying(Department of Obstetrics&Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310006;Department of Gynecology,Shaoxing Central Hospital,Shaoxing 312000)

机构地区：[1]浙江大学医学院附属邵逸夫医院妇产科,杭州310006 [2]绍兴市中心医院医共体总院妇科,绍兴312000

出　　处：《生殖医学杂志》2024年第11期1496-1502,共7页Journal of Reproductive Medicine

摘　　要：目的总结不同手术时机的经阴道宫颈峡部环扎术对宫颈锥切术后宫颈机能不全患者妊娠结局的影响。方法回顾性分析浙江大学医学院附属邵逸夫医院妇科自2015年1月1日至2022年12月31日收治的因宫颈锥切术后宫颈机能不全行择期经阴道宫颈峡部环扎术并且已有妊娠结局的154例患者的临床资料,其中孕前行宫颈环扎术者58例(孕前组)、孕期行宫颈环扎术者96例(孕期组),比较两组患者的一般情况和妊娠结局,进一步行多重线性回归分析两组经阴道宫颈环扎术对分娩孕周的影响。结果两组患者的平均年龄、术前宫颈管长度、宫腔操作次数、宫颈病变等级、妊娠方式等一般资料比较,差异均无统计学意义(P>0.05)。与孕前组相比,孕期组分娩孕周显著延长[(37.46±1.87)周vs.(36.71±2.14)周,P=0.023],但术中平均出血量显著增加[(75.52±18.00)ml vs.(19.91±19.00)ml,P<0.001];两组间早产率、剖宫产率、胎膜早破率、活产率及新生儿体重比较均无统计学差异(P>0.05)。多重线性回归分析结果发现,环扎手术时机(孕期vs.孕前)对分娩孕周的影响有统计学意义(b=0.695,t=2.291,P=0.023)。结论在宫颈锥切术后宫颈机能不全患者行择期宫颈峡部环扎的手术时机上,孕期宫颈环扎更能延长分娩孕周。Objective:To study the effect of transvaginal cervical isthmus ligation with different surgical timing on pregnancy outcomes in patients with cervical incompetence after cervical conization.Methods:A retrospective analysis was conducted on 154 patients admitted to Department of Obstetrics&Gynecology,Sir Run Run Shaw Hospital from January 2015 to December 2022 for elective transvaginal cervical isthmus cerclage due to cervical incompetence after cervical conization and who had a pregnancy outcome.Of which 58 patients underwent cervical cerclage before pregnancy(pre-pregnancy group),and 96 patients underwent cervical cerclage during pregnancy(pregnancy group).General characteristics and pregnancy outcomes between two groups were compared,and a multiple linear regression analysis was employed to analyze the possible influencing factors of the gestational weeks of delivery.Results:There were no significant differences in the average age,preoperative cervical canal length,the number of intrauterine operations,the grade of cervical lesions,and the mode of pregnancy between the two groups(P>0.05).Compared with the pre-pregnancy group,the gestational weeks of delivery in the pregnancy group was significantly longer[(37.46±1.87)weeks vs.(36.71±2.14)weeks,P=0.023],but the average amount of intraoperative bleeding was significantly higher[(75.52±18.00)ml vs.(19.91±19.00)ml,P<0.001].There were no significant differences between the two groups in the rates of preterm delivery,cesarean section,preterm rupture of membranes and live birth as well as the neonatal weight(P>0.05).Multiple linear regression analysis showed that the timing of cerclage(pregnancy vs.pre-pregnancy)had a significant effect on the gestational weeks of delivery(b=0.695,t=2.291,P=0.023).Conclusions:As for the timing of elective cervical isthmus cerclage in patients with cervical incompetence after cervical conization,cervical cerclage during pregnancy is more likely to prolong the gestational weeks of delivery.

关 键 词：宫颈机能不全 宫颈环扎术 宫颈锥切术 手术时机 妊娠结局 

分 类 号：R711.74[医药卫生—妇产科学]