腹腔镜下宫颈峡部环扎术治疗孕期宫颈机能不全的临床效果分析  

Analysis on the Clinical Effect of Laparoscopic Cervical Isthmic Cerclage in the Treatment of Cervical Incompetence During Pregnancy

作　　者：丁姝文 马鹏涛 王晓丽 张红娟 DING Shuwen;MA Pengtao;WANG Xiaoli;ZHANG Hongjuan(Department of Gynecology and Obstetrics,the 988th Hospital of PLA Joint Logistic Support Force,Zhengzhou 450000,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院妇产科,河南郑州450000

出　　处：《临床医学工程》2025年第4期349-352,共4页Clinical Medicine & Engineering

基　　金：河南省医学科技攻关计划联合共建项目(项目编号:LHGJ20210808)。

摘　　要：目的分析腹腔镜下宫颈峡部环扎术治疗孕期宫颈机能不全(CIC)的临床效果。方法选择我院2022年7月至2024年3月收治的83例孕期CIC患者,依照手术方法不同分为腹腔镜组(42例,接受腹腔镜下宫颈峡部环扎术治疗)与阴道组(41例,接受经阴道宫颈峡部环扎术治疗)。比较两组患者的围术期相关指标、妊娠结局、宫颈弹性成像参数[弹性对比指数(ECI)、宫颈长度(CL)、硬度比(HR)]、术后并发症发生情况。结果与阴道组相比,腹腔镜组手术及住院时间明显较短,术中出血量明显较少(P<0.05)。腹腔镜组流产率、早产率分别为7.14%、21.43%,明显低于阴道组的24.39%、41.46%(P<0.05)。腹腔镜组足月产率为71.43%,明显高于阴道组的34.15%(P<0.05)。腹腔镜组分娩孕周为(35.61±1.97)周,明显长于阴道组的(29.28±2.31)周(P<0.05)。腹腔镜组术后并发症发生率为9.52%,明显低于阴道组的26.83%(P<0.05)。术后1 d,两组的ECI、CL、HR均较术前得到改善,且腹腔镜组CL明显长于阴道组(P<0.05),而两组的ECI、HR比较,差异无统计学意义(P>0.05)。结论腹腔镜下宫颈峡部环扎术能够缩短孕期CIC患者的手术时间,减少术中出血量,延长CL,改善妊娠结局,降低术后并发症发生风险。Objective To analyze the clinical effect of laparoscopic cervical isthmic cerclage in the treatment of cervical incompetence(CIC)during pregnancy.Methods 83 pregnant CIC patients admitted to our hospital from July 2022 to March 2024 were selected and divided into laparoscopic group(42 cases,laparoscopic cervical isthmic cerclage)and vaginal group(41 cases,transvaginal cerclage isthmic cerclage)according to different surgical methods.The perioperative related indicators,pregnancy outcomes,cervical elastic imaging parameters[elastic contrast index(ECI),cervical length(CL),hardness ratio(HR)]and postoperative complications were compared between the two groups.Results Compared with the vaginal group,the operation time and hospitalization time of the laparoscopic group were significantly shorter,and the intraoperative blood loss was significantly less(P<0.05).The abortion rate and premature delivery rate of the laparoscopic group were 7.14%and 21.43%,respectively,significantly lower than 24.39%and 41.46%of the vaginal group(P<0.05).The full-term delivery rate of the laparoscopic group was 71.43%,significantly higher than 34.15%of the vaginal group(P<0.05).The delivery gestational age of the laparoscopic group was(35.61±1.97)weeks,significantly longer than(29.28±2.31)weeks of the vaginal group(P<0.05).The incidence of postoperative complications in the laparoscopic group was 9.52%,significantly lower than 26.83%in the vaginal group(P<0.05).1 day after surgery,the ECI,CL and HR in both groups improved compared with those before surgery,and the CL of the laparoscopic group was longer than that of the vaginal group(P<0.05),while no statistically significant difference was found in the ECI and HR between the two groups(P>0.05).Conclusions Laparoscopic cervical isthmic cerclage can shorten the operation time of CIC patients during pregnancy,reduce the intraoperative blood loss,prolong the CL,improve the pregnancy outcomes,and reduce the risk of postoperative complications.

关 键 词：腹腔镜 宫颈峡部环扎术 孕期宫颈机能不全 妊娠结局 并发症 

分 类 号：R713.4[医药卫生—妇产科学]