[1]管祎祺 韩劲松* 张坤 王永清 李华 杨俊芳.孕前宫颈环扎术治疗宫颈机能不全20例[J].中国微创外科杂志,2021,01(8):755-758.
　Guan Yiqi,Han Jinsong,Zhang Kun,et al.Curative Effect of Prepregnancy Cervical Cerclage in 20 Cases of Cervical Incompetence[J].Chinese Journal of Minimally Invasive Surgery,2021,01(8):755-758.
点击复制

孕前宫颈环扎术治疗宫颈机能不全20例()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年8期
页码:
755-758
栏目:
经验交流
出版日期:
2021-08-25

文章信息/Info

Title:
Curative Effect of Prepregnancy Cervical Cerclage in 20 Cases of Cervical Incompetence
作者:
管祎祺 韩劲松* 张坤 王永清 李华 杨俊芳
（北京大学第三医院妇产科，北京100191）
Author(s):
Guan Yiqi;  Han Jinsong;  Zhang Kun;  et al.
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
关键词:
宫颈机能不全; 孕前宫颈环扎术; 流产
Keywords:
Cervical incompetence; Prepregnancy cervical cerclage; Abortion
文献标志码:
B
摘要:
目的探讨孕前宫颈环扎术治疗宫颈机能不全的疗效。方法回顾分析我科2017年1月～2020年6月20例宫颈机能不全孕前行腹腔镜或经阴道宫颈环扎的临床资料。16例行腹腔镜宫颈环扎术，利用简易举宫器，于子宫峡部外1/3浆肌层由后向前或由前向后进针环扎宫颈内口；4例行经阴道宫颈环扎术，上推膀胱后打开后穹隆阴道黏膜至宫颈筋膜，向上分离至宫颈内口上1 cm，于宫颈内口水平缝合宫颈1/2肌层1周。结果20例手术顺利，手术时间(40.9±12.1)min，术中出血量（7.8±4.3）ml。腹腔镜宫颈环扎术16例术中出血（7.9±4.7）ml；12例术后妊娠，其中9例已分娩（7例足月分娩）。经阴道宫颈环扎术4例术中出血（7.5±2.9）ml；2例术后妊娠，其中1例足月顺产，1例目前孕30周。7例有中孕期宫颈环扎失败史中，5例术后妊娠,其中3例已分娩，分娩孕周分别为35、36+5、38+1孕周，1例尚在孕期，1例早孕期胚胎停育。结论对于宫颈机能不全的患者，尤其是经历孕期宫颈环扎术后失败的患者，孕前行宫颈环扎术是一种简单、安全、有效的方法。
Abstract:
ObjectiveTo investigate the efficacy of prepregnancy cervical cerclage for patients with cervical incompetence.MethodsClinical data of 20 patients with cervical incompetence who underwent prepregnancy laparoscopic or transvaginal cerclage in our hospital from January 2017 to June 2020 were retrospectively reviewed. Laparoscopic cervical cerclage was carried out in 16 cases by using a simple uterine lifting device, with the needle inserted into the outer 1/3 of the uterine isthmus from back to front or from front to back to cerclage the cervical orifice. Four cases underwent transvaginal cervical cerclage. After pushing up the bladder, the vaginal mucosa of the posterior fornix was opened to the cervical fascia, and separated upward to 1 cm above the inner mouth of the cervix.ResultsAll the operations went on smoothly. The surgical time was (40.9±12.1) min, and the volume of blood loss was (7.8±4.3) ml. There were 16 cases of intraoperative bleeding during laparoscopic cervical cerclage (7.9±4.7) ml. Among them, there were 12 cases of postoperative pregnancy, of which 9 cases had delivered (7 cases of fullterm delivery). There were 4 cases of bleeding during transvaginal cervical cerclage (7.5±2.9) ml. Among them, there were 2 cases of postoperative pregnancy, of which 1 case had fullterm natural labor and 1 case was currently 30 weeks of pregnancy. Among the 7 cases with failure of cervical cerclage in the second trimester, 5 cases were pregnant after operation, of which 3 cases had delivered. The gestational weeks of delivery were 35, 36+5, and 38+1 weeks, respectively, and 1 case was still in pregnancy and 1 case had embryo suspension in the first trimester.ConclusionThe prepregnancy cervical cerclage is a simple, safe, and effective treatment for cervical incompetence, especially for those who have a failed vaginal cervical cerclage.

参考文献/References:

[1]王红梅,王谢桐.宫颈机能不全的诊断及处理.现代妇产科进展,2011,20（3）:180-182.
[2]雷庆华,柯青霞,赖葵凤,等.孕前腹腔镜子宫峡部环扎术治疗宫颈机能不全的临床研究.中国现代医生,2016,54（23）:43-45.
[3]夏恩兰.孕前腹腔镜子宫颈峡部环扎术.中华腔镜外科杂志（电子版）,2012,5(2):86-89.
[4]Harger JH. Cerclage and cervical insufficiency: an evidencebased analysis. Obstetr Gynecol,2002,100(6):1313-1327.
[5]Ciancimino L,Laganà AS, Imbesi G,et al. Evaluation of maternalfetal outcomes after emergency vaginal cerclage performed with ShirodkarMcDonald combined modified technique. J Clin Med Res,2015,7(5):319-323.
[6]Zhu LQ, Chen H, Chen LB,et al. Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases. Med Sci Monit,2015,21（5）:1395-1401.
[7]Novy MJ, Gupta A, Wothe DD,et al. Cervical cerclage in the second trimester of pregnancy: a historical cohort study. Am J Obstetr Gynecol,2001,184(7):1447-1456.
[8]李全香,高艳华,严凤.孕前环扎在宫颈功能不全治疗中的临床价值.中国保健营养,2017,27(24):54.
[9]禤坚艳,郑玉华,汪洪,等.孕前期腹腔镜下宫颈环扎术治疗宫颈机能不全的临床效果.中国计划生育学杂志,2018,26(4):308-310,321.
[10]赵玉婷,黄晓武,夏恩兰,等.孕前“极简式”腹腔镜下宫颈环扎术的临床应用.国际妇产科学杂志,2016,43(6):634-637.
[11]罗文斌,罗晓青,张羡,等.腹腔镜子宫颈环扎术后妊娠晚期自发性子宫破裂一例及文献复习.中华妇产科杂志,2016,51(5):371-372.
[12]Rand L, Norwitz ER. Current controversies in cervical cerclage. Semin Perinatol,2003,27(1):73-85.
[13]张松英,金晓莹,徐文治.孕前经阴道子宫颈峡部环扎术治疗宫颈机能不全.中国实用妇科与产科杂志,2014,30(2):99-101.
[14]Hawkins E, Nimaroff M. Vaginal erosion of an abdominal cerclage 7 years after laparoscopic placement. Obstetr Gynecol,2014,123(2):420-423.
[15]姚书忠.宫颈机能不全诊治过程中存在的争议和思考.中国实用妇科与产科杂志,2017,33(1):31-35.

备注/Memo

备注/Memo:
*通讯作者，Email：hanjinsong353@sina.com
更新日期/Last Update: 2021-11-04