疑似宫颈机能不全患者不同治疗方法对妊娠结局的影响
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摘要
目的探讨疑似宫颈机能不全患者采用不同治疗方法对妊娠结局的影响。方法回顾性分析2016年1月1日至12月31日在我院产科建档的疑似宫颈机能不全孕妇(197例)的临床资料,根据治疗方法的不同分为2组:宫颈环扎组(89例)行宫颈环扎术(均采用McDonald术式),保守治疗组(108例)采用保守治疗(口服地屈孕酮片)。记录并比较两组患者的足月产、早产、流产比例、分娩孕周情况,及新生儿出生结局等。结果宫颈环扎组的妊娠成功率(77.53%)显著低于保守治疗组(91.67%)(P<0.05)。宫颈环扎组患者32～33+6周的早产率与保守治疗组比较无显著性差异(P>0.05),而28～31+6周和34～36+6周的早产率显著高于保守治疗组(分别为7.87%vs.1.85%和22.47%vs.8.33%)(P<0.05)。两组患者早产儿平均分娩孕周比较无显著性差异(P>0.05)。两组患者的活婴数量、转儿科数量及新生儿出生体重比较亦无显著性差异(P>0.05)。结论以超声指征诊断的疑似宫颈机能不全患者,行宫颈环扎术并不能显著改善宫颈缩短者的围产结局,临床医师应对这类患者行进一步的确诊,避免过度治疗。
Objective:To investigate the effect of different treatments on pregnancy outcome in patients with suspicious cervical insufficiency.Methods: A retrospective analysis was made of 197 pregnant women suspected of cervical incompetence in our obstetrics department from January 1,2016 to December 31,2016.According to the different treatments,the patients were divided into two groups:cervical cerclage group by using McDonald operation(n=89),conservative treatment group with oral dextroprogesterone tablets(n=108).The fullterm,premature,abortion rate,gestational age of delivery,and neonatal birth outcomes in the two groups were recorded and compared.Results:The pregnancy success rate of cervical cerclage group(77.53%)was significantly lower than that of conservative treatment group(91.67%)(P <0.05).There was no significant difference in premature rate at 32-33+6 weeks between the two groups(P>0.05).However,the premature rate at28-31+6 weeks(7.87% vs.1.85%)and 34-36+6 weeks(22.47% vs.8.33%)in the cervical cerclage group was significantly higher than that in the conservative treatment group(P<0.05).There was no significant difference in the gestational age between the two groups(P>0.05).There was no significant difference in the number of live babies,the number of referral to pediatrics and the birth weight of newborns between the two groups(P>0.05).Conclusions:The perinatal outcome of conservative treatment is better than that of cervical cerclage in the patients with suspected cervical function diagnosed by ultrasound.Clinicians should make further diagnosis and avoid over-treatment.
Objective:To investigate the effect of different treatments on pregnancy outcome in patients with suspicious cervical insufficiency.Methods: A retrospective analysis was made of 197 pregnant women suspected of cervical incompetence in our obstetrics department from January 1,2016 to December 31,2016.According to the different treatments,the patients were divided into two groups:cervical cerclage group by using McDonald operation(n=89),conservative treatment group with oral dextroprogesterone tablets(n=108).The fullterm,premature,abortion rate,gestational age of delivery,and neonatal birth outcomes in the two groups were recorded and compared.Results:The pregnancy success rate of cervical cerclage group(77.53%)was significantly lower than that of conservative treatment group(91.67%)(P <0.05).There was no significant difference in premature rate at 32-33+6 weeks between the two groups(P>0.05).However,the premature rate at28-31+6 weeks(7.87% vs.1.85%)and 34-36+6 weeks(22.47% vs.8.33%)in the cervical cerclage group was significantly higher than that in the conservative treatment group(P<0.05).There was no significant difference in the gestational age between the two groups(P>0.05).There was no significant difference in the number of live babies,the number of referral to pediatrics and the birth weight of newborns between the two groups(P>0.05).Conclusions:The perinatal outcome of conservative treatment is better than that of cervical cerclage in the patients with suspected cervical function diagnosed by ultrasound.Clinicians should make further diagnosis and avoid over-treatment.
引文
[1]姚书忠.宫颈机能不全诊治过程中存在的争议和思考[J].中国实用妇科与产科杂志,2017,33:31-35.
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[3]李雪,高爱华,张迎春,等.宫颈机能不全宫颈环扎术手术指征探讨[J].中国实用妇科与产科杂志,2017,33:315-318.
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[9]郑秀琼,谢熙,刘超斌,等.子宫颈环扎术治疗妊娠期子宫颈机能不全的临床价值[J].中国妇产科临床杂志,2017,18:170-172.
[10]Mitric C,Ponette V.Successful rescue cerclage in a monochorionic diamniotic twin pregnancy at 20weeks:case report and overview of literature[J].J Obstet Gynaecol Can,2018,40:473-475.
[11]黄晓武.宫颈发育异常与生育相关问题[J].实用妇产科杂志,2018,34:95-97.
[12]孟钊,谢芳,李洁明.宫颈环形电切术不同宫颈切除深度对宫颈上皮内瘤变患者宫颈机能及生存质量的影响[J].山东医药,2015,55:57-59.
[13]Vigoureux S,Neveu ME,Capmas P,et al.Re:Three-dimensional ultrasound imaging of intra-abdominal cervical-isthmus cerclage[J].Ultrasound Obstet Gynecol,2018,52:124-125.
[14]王伟,姚书忠.妊娠期宫颈机能不全诊治[J].实用妇产科杂志,2018,34:90-93.
[15]王海玲,杨孜.紧急宫颈环扎术的临床应用研究进展[J].中国妇产科临床杂志,2016,17:474-476.
[16]Zanatta A,de Carvalho BR,Amaral K,et al.Laparoscopic interval isthmocervical cerclage with cardiac tape in a patient with previous cervical amputation[J].J Minim Invasive Gynecol,2015,22:536-537.
[2]刘朵朵,葛俊丽,吕小慧,等.紧急宫颈环扎术治疗宫颈机能不全致晚期流产和早产的临床应用价值[J].实用妇产科杂志,2016,32:926-929.
[3]李雪,高爱华,张迎春,等.宫颈机能不全宫颈环扎术手术指征探讨[J].中国实用妇科与产科杂志,2017,33:315-318.
[4]王硕石,陈淑滢,钟梅.宫颈环扎指南解读[J].实用妇产科杂志,2015,31:26-29.
[5]Barsky M,Kelley R,Bhora FY,et al.Customized pessary fabrication using Three-Dimensional printing technology[J].Obstet Gynecol,2018,131:493-497.
[6]祝丽琼,张建平,陈少青.三种时机宫颈环扎术的临床对比研究[J].生殖医学杂志,2009,18:269-271.
[7]邹杉,孙丽洲.宫颈环扎术治疗宫颈机能不全的临床效果评价[J].南京医科大学学报(自然科学版),2015,35:1443-1446.
[8]李雪,张弘.宫颈机能不全环扎与早产[J].中国实用妇科与产科杂志,2018,34:146-150.
[9]郑秀琼,谢熙,刘超斌,等.子宫颈环扎术治疗妊娠期子宫颈机能不全的临床价值[J].中国妇产科临床杂志,2017,18:170-172.
[10]Mitric C,Ponette V.Successful rescue cerclage in a monochorionic diamniotic twin pregnancy at 20weeks:case report and overview of literature[J].J Obstet Gynaecol Can,2018,40:473-475.
[11]黄晓武.宫颈发育异常与生育相关问题[J].实用妇产科杂志,2018,34:95-97.
[12]孟钊,谢芳,李洁明.宫颈环形电切术不同宫颈切除深度对宫颈上皮内瘤变患者宫颈机能及生存质量的影响[J].山东医药,2015,55:57-59.
[13]Vigoureux S,Neveu ME,Capmas P,et al.Re:Three-dimensional ultrasound imaging of intra-abdominal cervical-isthmus cerclage[J].Ultrasound Obstet Gynecol,2018,52:124-125.
[14]王伟,姚书忠.妊娠期宫颈机能不全诊治[J].实用妇产科杂志,2018,34:90-93.
[15]王海玲,杨孜.紧急宫颈环扎术的临床应用研究进展[J].中国妇产科临床杂志,2016,17:474-476.
[16]Zanatta A,de Carvalho BR,Amaral K,et al.Laparoscopic interval isthmocervical cerclage with cardiac tape in a patient with previous cervical amputation[J].J Minim Invasive Gynecol,2015,22:536-537.