宫颈机能不全宫颈环扎术手术指征探讨

摘要

目的 探讨宫颈机能不全行宫颈环扎术的手术指征.方法 选择2009年7月至2015年3月就诊于苏州大学附属第二医院的宫颈机能不全患者273例,分为宫颈环扎组(n=178),期待疗法组(n=95);273例再按既往晚期流产次数分层,分为1次晚期流产环扎组(A1组,n=76),1次晚期流产期待组(B1组,n=52);2次晚期流产环扎组(A2组,n=88),2次晚期流产期待组(B2组,n=40),分析对比组间的临床资料及妊娠结局.另有14例3次及以上晚期流产史宫颈环扎术者未行分层对比分析.结果 178例宫颈环扎患者活产率为88.76％,流产率11.2％.95例期待疗法患者活产率低于宫颈环扎者.A1组患者的分娩孕周为(35.4±1.9)周,与B1组(30.8±2.4)周相比,差异有统计学意义(P＜0.05).A1组新生儿出生体重与B1组相比,差异有统计学意义(P＜0.05).A2组患者分娩孕周、早产率、新生儿出生体重与B2组比较,差异有统计学意义(P＜0.05).结论 对有两次晚期自然流产史的患者,行宫颈环扎术可以明显改善妊娠结局.%Objective To investigate the surgical indication of cervical cerclage for cervical incompetence.Methods From July 2009 to March 2015,a clinical randomized trial was carried out on 273 patients with cervical incompetence.In 178 cases,a McDonald suture was inserted,and in 95 cases,the pregnancy was managed expectantly.According to the number of previous second-trimester loss,the patients were divided into 4 groups,one spontaneous abortion:A1 group (cervical cerclage,n=76),B 1 group(expectant management,n=52);two spontaneous abortion:A2 group (cervical cerclage,n=88),B2 group(expectant management,n=40).Results Among the cervical cerclage group,the rate of live birth was 88.76％,and the rate of abortion was 11.2％.The live birth rate of expectant group was lower than that of the cerclage group.A significant difference was found in gestation age between A 1 group (35.4± 1.9)w and B 1 group (30.8±2.4)w,P＜0.05.Patients of A1 group could get heavier neonate birth weight than B1 group.There was significant difference between A2 group and B2 group in the gestational age,the incidence of preterm birth and neonate birth weight (P ＜ 0.05).Conclusion For cervical incompetence patients with recurrent second-trimester pregnancy miscarriage,cervical cerclage can effectively improve pregnancy outcome.