McDonald改良术式治疗宫颈机能不全妊娠的临床结局  

Clinical outcome of modified McDonald’s procedure for the treatment of pregnancies with cervical insufficiency

作　　者：龙娟[1] 刘育松 潘红英 任旭雯 刘健玲 LONG Juan;LIU Yusong;PAN Hongying;REN Xuwen;LIU Jianing(Obstetrics Department,the Sixth Affiliated Hospital of South China University of Technology,Foshan 528200,China)

机构地区：[1]华南理工大学附属第六医院产科,佛山528200

出　　处：《新医学》2025年第4期395-401,共7页Journal of New Medicine

基　　金：佛山市科技创新项目(2330001006319)。

摘　　要：目的 探讨McDonald改良术式治疗宫颈机能不全妊娠的临床结局。方法 回顾性分析2012年1月至2022年12月在华南理工大学附属第六医院行McDonald改良术式的113例宫颈机能不全单胎妊娠孕妇临床资料。根据手术目的分为预防性环扎组(n=23)和治疗性环扎组(n=90)。记录2组孕妇的一般情况、妊娠结局以及术后并发症和新生儿情况。以治疗性环扎术是否不良预后(流产)为因变量进行多因素Logistic回归分析。结果 与治疗性环扎组比较,预防性环扎组孕妇的孕次较多、孕周较短、2次及以上不良孕产史者和宫内感染者比例较高(均P <0.05)。2组术后其他并发症、新生儿的出生体质量和新生儿1 min阿普加评分比较差异均无统计学意义(均P> 0.05)。单因素分析显示,宫口扩张、尿路感染对治疗性环扎组孕妇妊娠结局有一定影响(均P <0.05)。多因素Logistic回归分析显示,宫口扩张、尿路感染为治疗性环扎术孕妇出现不良预后的影响因素(均P <0.05)。结论 宫口扩张、尿路感染为治疗性环扎术孕妇流产的影响因素,对该类孕妇应早期监测宫颈及宫内感染情况、及时治疗感染并适时进行宫颈环扎术以改善母婴结局。Objective To investigate the clinical outcome of modified McDonald’s procedure for the treatment of pregnant women with cervical insufficiency.Methods Clinical data of 113 women with singleton pregnancies with cervical insufficiency who underwent negative low cervical cerclage in the Sixth Affiliated Hospital of South China University of Technology from January 2012 to December 2022 were retrospectively analyzed.They were categorized into prophylactic cervical cerclage group(n=23)and therapeutic cervical cerclage group(n=90)according to the purpose of the procedure.The general status,pregnancy outcome,postoperative complications and neonatal status in two groups were recorded.Multivariate Logistic regression analysis was carried out with whether therapeutic cervical cerclage yielded poor prognosis(abortion)as the dependent variable.Results In the prophylactic cervical cerclage group,the number of pregnancy was higher,the gestational week was shorter,the proportions of women with a history of≥2 previous mid-pregnancy miscarriages or preterm deliveries and intrauterine infection were higher than those in the therapeutic cervical cerclage group(all P<0.05).The differences were not statistically significant in post-operative comorbidities,neonatal birth quality,and 1-min neonatal Apgar scores between two groups(all P>0.05).Univariate analysis showed that cervical dilatation and urinary tract infection exerted certain effects on the pregnancy outcome of pregnant women in the therapeutic cervical cerclage group(both P<0.05).Multivariate Logistic regression analysis demonstrated that cervical dilatation and urinary tract infection were the influencing factors for poor prognosis of pregnant women undergoing therapeutic cervical cerclage(both P<0.05).Conclusions Dilatation of the cervix and urinary tract infection are the main risk factors affecting the outcome of therapeutic cervical cerclage.For these pregnant women,early monitoring of the cervical condition,prompt treatment of urinary tract infection,and timely ce

关 键 词：宫颈机能不全 宫颈环扎术 McDonald改良术式 妊娠 手术治疗 

分 类 号：R713.4[医药卫生—妇产科学]