宫颈环扎术治疗宫颈机能不全的妊娠结局
| 作者: |
1陈圆圆,
1李佳雯,
1南星宇,
1殷科,
1朱云龙,
1黄璐
1 南京医科大学附属无锡妇幼保健院妇产科，江苏 无锡 214002 |
| 通讯: |
黄璐
Email: huanglusz@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2022.02.022 |
| 基金: | 江苏省卫生健康委科研项目 (LGY2018015)；无锡市卫计委拔尖人才项目 (BJ2020081)。 |
摘要
目的：探讨择期和紧急不同宫颈环扎术对治疗宫颈机能不全及对延长孕周和预防早产的作用。方法：纳入2017年1月至2020年6月在无锡市妇幼保健院因宫颈机能不全进行治疗的70例患者，根据孕周和手术时间不同分为择期环扎组与紧急环扎组，比较2组的治疗效果及妊娠结局。结果：70例患者行宫颈环扎术的成功率为100%，早产发生率为20.85%，2组在环扎孕周、宫颈管长度、延长孕周等方面的差异均有统计学意义(均P<0.01)，紧急环扎组的早产发生率较高(P<0.05)。Pearson相关分析显示延长妊娠时间和早产发生率呈明显负相关(r=−0.490，P<0.01)，宫颈管长度与早产发生率呈明显负相关(r=−0.270，P<0.01)，延长妊娠时间与宫颈管长度呈明显正相关(r=0.792，P<0.01)。Cox比例危险回归分析显示紧急环扎术是早产发生的独立危险因素，择期环扎组发生早产的风险显著低于紧急环扎组(HR=2.184，95%CI：1.798~2.651，P<0.05)。结论：与紧急环扎相比，择期宫颈环扎术具有更好的临床效果，预防早产的效果优于紧急环扎术，孕期筛选高危产妇后，择期进行宫颈环扎术有利于延长孕周，预防早产，值得临床推广。
关键词：
宫颈环扎术；宫颈机能不全；孕周；早产；妊娠结局
Pregnancy outcome of cervical cerclage in the treatment of cervical insufficiency
CorrespondingAuthor: HUANG Lu Email: huanglusz@163.com
DOI: 10.3978/j.issn.2095-6959.2022.02.022
Foundation: This work was supported by the Scienti c Research Project of Jiangsu Provincial Health Commission (LGY2018015) and the Top Talent Project of Wuxi Municipal Health and Family Planning Commission (BJ2020081), China.
Abstract
Objective: To explore the clinical pregnancy outcomes of elective cervical cerclage and emergency cervial cerclage in the treatment of cervical insufficiency, and the effects of cervical cerclage with different indications on prolonging the gestational period and preventing premature birth. Methods: A total of 70 patients treated for cervical insufficiency in Wuxi Maternity and Child Health Hospital from January 2017 to June 2020 were retrospectively studied. According to the gestational age and operation time, the patients were divided into an elective cervial cerclage group and an emergency cervial cerclage group. The treatment effect and pregnancy outcome of the 2 groups were compared. Results: The success rate of cervical cerclage was 100%, and the incidence rate of preterm delivery was 20.85%. Furthermore, there were significant differences between the 2 groups based on the gestational age for cervical cerclage, the canal length of the cervix, and the extension of the gestational period (P<0.01). The incidence rate of preterm delivery in the emergency cervical cerclage group was higher than that in the elective cervical cerclage group (P<0.05). Pearson correlation analysis showed that there was a significant negative correlation between the extension of the gestational period and preterm delivery rate (r=−0.490, P<0.01). Also, there was a significant negative correlation between the canal length of the cervix and the incidence rate of preterm delivery (r=−0.270, P<0.01). Furthermore, there was a positive correlation between the extension of gestational period and cervical canal length (r=0.792, P<0.01). Cox proportional hazard regression analysis showed that emergency cervical cerclage was an independent risk factor for preterm delivery. And the risk of preterm delivery in the elective cerclage group was significantly lower than that in the emergency cerclage group (HR =2.184, 95%CI: 1.798 to 2.651, P<0.05). Conclusion: The clinical effect of elective cervical ligation is better than that of the emergency cervical ligation, and the prevention of preterm delivery is more efficient in the elective cervical ligation group than that in the emergency cervical cerclage group. In the high-risk pregnant women screened out, elective cervical ligation may extend their gestation period and prevent the associated preterm delivery; hence, the treatment should be popularized clinically.
Keywords：
cervical cerclage; cervical incompetence; pregnancy period; preterm delivery; pregnancy outcome