孕前腹腔镜下宫颈环扎术与孕期McDonald宫颈环扎术对治疗宫颈机能不全的疗效比较

陈艳; 曲皖君; 胡卫平; 陈玲

doi:10.13898/j.cnki.issn.1000-2200.2019.09.017

孕前腹腔镜下宫颈环扎术与孕期McDonald宫颈环扎术对治疗宫颈机能不全的疗效比较

Comparison of the curative effect between pre-pregnancy laparoscopic cervix cerclage and McDonald cervical cerclage in the treatment of cervical dysfunction

摘要

摘要:
目的分析孕前腹腔镜下宫颈环扎术与孕期McDonald宫颈环扎术对治疗宫颈机能不全疗效的影响。
方法选取宫颈机能不全病人50例，根据手术方式不同分为2组，其中孕前行腹腔镜下宫颈环扎术（孕前组）24例，孕期行McDonald宫颈环扎术（孕期组）26例，比较2组手术情况及对母婴结局的影响。
结果2组病人均未中转开腹，无手术并发症发生。孕前组住院时间和术中出血量较孕期组减少（P < 0.01），2组手术时间比较差异无统计学意义（P>0.05）。孕期组住院保胎率及早产率均高于孕前组（P < 0.01和P < 0.05），而孕前组的足月产率高于孕期组（P < 0.01），但2组晚期流产率差异无统计学意义（P>0.05）。孕前组新生儿活产23例，均为剖宫产；孕期组新生儿活产22例，其中11例顺产分娩，11例为剖宫产。孕期组平均分娩孕周和新生儿体质量均低于孕前组（P < 0.05~P < 0.01），而新生儿窒息率和转NICU率高于孕前组（P < 0.05）。
结论孕前腹腔镜下宫颈环扎术住院时间短，术中出血量少，可减少孕期保胎，改善母婴结局，临床疗效较好，值得推广应用。

Abstract:
ObjectiveTo compared the effects between pre-pregnancy laparoscopic cervix cerclage and McDonald cervical cerclage in the treatment of cervical incompetence.
MethodsFifty patients with cervical incompetence were divided into the pre-pregnancy group(24 cases treatment with laparoscopic cervix cerclage) and pregnancy group(26 cases treatment with McDonald's cervical cerclage).The operation, and maternal and fetal outcomes between two groups were compared.
ResultsNo conversion to open laparotomyànd operative complication occurred in two groups.The hospital stays and intraoperative blood loss in pre-pregnancy group were lower than those in pregnancy group(P < 0.05), and the difference of operation time between two groups was not statistically significant(P>0.05).The prenatal pregnancy and preterm birth rates, and full-term delivery rate in pregnancy group were lower and higher than those in pregnancy group, respectively(P < 0.05), while the difference of the late abortion rate between two groups was not statistically significant(P>0.05).There were 23 live births of neonates, and all were cesarean section in pre-pregnancy group.There were 22 live births of neonates, 11 cases were cesarean section, and 11 cases were natural labour in pregnancy group.The average gestational week and neonatal body mass in pregnancy group were lower than those in pre-pregnancy group(P < 0.05 to P < 0.01), and the rates of neonatal asphyxia and transfer NICU in pregnancy group were higher than those in pre-pregnancy group(P < 0.05).
ConclusionsPre-pregnancy laparoscopic cervix cerclage in the treatment of cervical incompetence is short hospital stay and less bleeding during operation.It can reduce pregnancy spuc, and improve maternal and infant outcomes.It has good clinical effect, and is worth popularizing and applying.

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