目的 探讨不同宫颈长度的宫颈功能不全患者孕前宫颈环扎方法的选择.方法回顾性分析128例因宫颈功能不全行孕前宫颈环扎患者的临床资料,术前经阴道超声测量宫颈长度>2.5 cm者60例,其中行腹腔镜下宫颈环扎34例,经阴道宫颈环扎26例;宫颈长度≤2.5 cm者68例,其中行腹腔镜下宫颈环扎32例,经阴道宫颈环扎36例.结果对于术前宫颈长度>2.5 cm患者,不同宫颈环扎方法术后妊娠期宫颈长度、孕周延长时间、围生儿体质量、围生儿存活率、分娩孕周和宫腔感染率比较差异无统计学意义(P>0.05).对于术前宫颈长度≤2.5 cm患者,腹腔镜下宫颈环扎患者术后妊娠期宫颈长度、孕周延长时间、围生儿体质量、围生儿存活率和足月分娩率明显高于经阴道宫颈环扎患者[(3.85±0.37)cm比(3.16±0.49)cm、(101.75±4.71)d比(80.62±3.53)d、(2850±323)g比(2330±585)g、90.6%(29/32)比69.4%(25/36)和50.0%(16/32)比22.2%(8/36)],而宫腔感染率明显低于经阴道宫颈环扎患者[0比16.7%(6/36)],差异有统计学意义(P<0.05).患者均未发生明显手术并发症.结论宫颈长度>2.5 cm的宫颈功能不全患者,孕前宫颈环扎可选择经阴道或腹腔镜下;对于宫颈长度≤2.5 cm或既往宫颈环扎失败的宫颈功能不全患者,腹腔镜下宫颈环扎优于经阴道宫颈环扎.
Objective To study the pre- pregnancy cervical cerclage method in the different cervical length of uterine cervical incompetence patients. Methods The clinical data of 128 uterine cervical incompetence patients having underwent pre-pregnancy cervical cerclage were retrospectively analyzed. The preoperative cervical length was measured by transvaginal ultrasound. Cervical length >2.5 cm was in 60 cases, of which 34 cases underwent laparoscopic cervical cerclage, and 26 cases underwent transvaginal cervical cerclage; cervical length ≤ 2.5 cm was in 68 cases, of which 32 cases underwent laparoscopic cervical cerclage, and 36 cases underwent transvaginal cervical cerclage. Results For the patients with preoperative cervical length > 2.5 cm, there were no statistical differences in the postoperative pregnancy cervical length, gestational weeks time, perinatal birth weight, perinatal survival rate, gestational age of delivery and intrauterine infection rate between 2 methods (P>0.05). For the patients with preoperative cervical length ≤ 2.5 cm, the postoperative pregnancy cervical length, gestational weeks time, perinatal birth weight, perinatal survival rate and gestational age of delivery in laparoscopic cervical cerclage patients were significantly higher than those in transvaginal cervical cerclage patients: (3.85 ± 0.37) cm vs. (3.16 ± 0.49) cm, (101.75 ± 4.71) d vs. (80.62 ± 3.53) d, (2850 ± 323) g vs. (2330 ± 585) g, 90.6% (29/32) vs. 69.4% (25/36) and 50.0% (16/32) vs. 22.2%(8/36), but the intrauterine infection rate was significantly lower than that in transvaginal cervical cerclage patients:0 vs. 16.7%( 6/36), and there were statistical differences (P<0.05). All patients had no obvious complications. Conclusions For cervical length > 2.5 cm patients with uterine cervical incompetence, pre- pregnancy cervical cerclage can choose transvaginal or laparoscopic. But for patients with the cervical length≤2.5 cm or previous cervical cerclage failure, laparoscopic cervical cerclage is better than transvaginal cervical cerclage.