子宫颈机能不全双胎妊娠孕妇应用改良子宫颈环扎术的不同手术时机探讨  

Clinical study of modified cervical cerclage at different surgical timings in twin pregnant women with cervical insufficiency

作　　者：范延玮 赵广彩 杨思远 陈文惠 赵宁宁 刘海英 Fan Yanwei;Zhao Guangcai;Yang Siyuan;Chen Wenhui;Zhao Ningning;Liu Haiying(Department of Obstetrics,Qilu Hospital of Shandong University(Qingdao),Qingdao 266035,China;Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院(青岛)产科,青岛266035 [2]山东大学齐鲁医院妇产科,济南250012

出　　处：《中华妇产科杂志》2025年第2期105-113,共9页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨子宫颈机能不全双胎妊娠孕妇应用改良子宫颈环扎术的手术时机。方法回顾性分析2014年4月至2023年7月因子宫颈机能不全于山东大学齐鲁医院(青岛)行改良子宫颈环扎术且有妊娠结局的73例双胎妊娠孕妇的临床资料,根据手术时机的不同分为预防性环扎组、超声指征环扎组[进一步分为子宫颈长度(CL)≤15 mm与15 mm<CL<25 mm亚组]及紧急环扎组,比较3组孕妇的妊娠结局及新生儿结局的差异。比较分娩孕周<34周与≥34周孕妇的临床资料及妊娠结局,并采用多因素logistic回归分析妊娠34周前早产的影响因素。结果(1)预防性环扎组孕妇的延长孕周、术后CL较超声指征环扎组延长;预防性环扎组孕妇的分娩孕周、延长孕周、术后CL、活产率、新生儿出生体重较紧急环扎组升高,妊娠34、32及28周前早产率、胎膜早破发生率较紧急环扎组降低;超声指征环扎组孕妇的分娩孕周、延长孕周、术后CL、活产率、新生儿出生体重较紧急环扎组升高,妊娠34、32及28周前早产率、新生儿出生体重<1500 g发生率较紧急环扎组降低;分别比较,差异均有统计学意义(P均<0.05)。Kaplan-Meier曲线分析表明,预防性环扎组及超声指征环扎组的累积未分娩率均显著高于紧急环扎组(P均<0.05)。(2)15 mm<CL<25 mm亚组的延长孕周、术后CL较CL≤15 mm亚组延长,CL≤15 mm亚组的分娩孕周、新生儿出生体重较紧急环扎组升高,妊娠32周前早产率、新生儿出生体重<1500 g发生率较紧急环扎组显著降低(P均<0.05)。(3)分娩孕周<34周孕妇的子宫颈阴道分泌物异常发生率、术后C反应蛋白(CRP)水平较分娩孕周≥34周孕妇显著升高,术前CL、术后CL较分娩孕周≥34周孕妇显著缩短(P均<0.05)。多因素logistic回归分析表明,术后CRP>10 mg/L是妊娠34周前早产的独立危险因素(OR=5.230,95%CI为1.616~16.929;P=0.006)。结论子宫颈机能不全双胎妊娠孕妇中,�ObjectiveTo explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency.MethodsThe clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University(Qingdao)from April 2014 to July 2023 were retrospectively analyzed.According to the different timings of surgery,they were divided into prophylactic cerclage group,ultrasound-indicated cerclage group(further divided into cervical length(CL)≤15 mm and 15 mm<CL<25 mm subgroups)and emergency cerclage group.The differences in pregnancy and neonatal outcomes among the three groups were compared.The clinical data and pregnancy outcomes of pregnant women delivered at<34 weeks and≥34 weeks were compared,and multivariate logistic regression was used to analyze the influencing factors of preterm birth before 34 weeks.Results(1)The prolonged gestational age and postoperative CL in the prophylactic cerclage group were longer than those in the ultrasound-indicated cerclage group;the gestational age at delivery,prolonged gestational age,postoperative CL,live birth rate and neonatal birth weight in the prophylactic cerclage group were higher than those in the ultrasound-indicated cerclage group,and the preterm birth rate before 34,32 and 28 weeks of gestation and premature rupture of membranes were lower than those in the emergency cerclage group;the gestational age of delivery,prolonged gestational age,postoperative CL,live birth rate and the rate of neonatal birth weight of the pregnant women in the ultrasound-indicated cerclage group were higher than those in the emergency cerclage group,and the rate of premature birth before 34,32 and 28 weeks of gestation and late neonatal birth weight<1500 g were lower than those in the emergency cerclage group;the differences were statistically significant(all P<0.05).(2)The gestational age and postoperative CL in the 15 mm<CL<25 mm group were longer than those in the CL�

关 键 词：妊娠 双胎 宫颈功能不全 环扎术 宫颈 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]