非孕期与孕期腹腔镜下改良式宫颈环扎术治疗宫颈机能不全的疗效比较

Modified laparoscopic transabdominal cervico-isthmic cerclage in the management of cervical insufficiency in pre and post-conceptional women

关键词:  腹腔镜下宫颈环扎术  宫颈机能不全  非孕期  孕期

Key words:  laparoscopic transabdominal cervico-isthmic cerclage  cervical insufficiency  non-pregancy  pregancy

摘要:

目的 探讨非孕期与孕期腹腔镜下改良式宫颈环扎术（MLTCC）治疗宫颈机能不全的安全性及疗效。方法 回顾性分析2014年1月至2018年12月于沈阳市妇婴医院因宫颈机能不全行MLTCC的患者共92例，按手术时机分为非孕期组（n=58）和孕期组（n=34）。比较两组手术相关指标、术后妊娠情况及新生儿结局，同时比较MLTCC不同环扎参数对妊娠结局的影响。结果 非孕期及孕期手术成功率分别为86.7%、94.3%。孕期组术中失血量多于非孕期组（80.0 mL vs.22.5 mL，P=0.002）。两组宫颈环扎手术时间、术后住院时间、围手术期及远期并发症发生率、手术成功率、妊娠晚期宫颈长度、术后妊娠结局（分娩孕周、晚期流产率、早产率、足月产率）及新生儿结局（新生儿存活率、体质量、患病率）比较，差异均无统计学意义（P均>0.05）。不同环扎参数（环扎带数量及打结数目）下分娩孕周、新生儿体质量及妊娠晚期宫颈长度比较，差异均无统计学意义（P均>0.05）。结论 MLTCC可有效改善宫颈机能不全患者术后妊娠结局；与孕期手术相比，非孕期手术可获得相似效果，但手术风险更小；双重环扎及增加环扎带打结数量对术后妊娠结局均无明显影响。

Abstract:

Objective To investigate the safety and efficacy of modified laparoscopic transabdominal cervico-isthmic cerclage (MLTCC) in the management of cervical insufficiency in pre and post-conceptional women. Methods A historical cohort study was conducted in Shenyang Women's and Children's hospital from January 2014 to December 2018. A total of 92 patients underwent laparoscopic transabdominal cervico-isthmic cerclage to treat cervical insufficiency, including 58 pregnant (preconceptional group) and 34 non-pregnant patients (postconceptional group). Perioperative data, postoperative pregnancy outcomes and neonatal outcomes were compared between two groups. The efficacy of different MLTCC parameters on obstetric outcomes were compared at the same time. Results The success rate of MLTCC was 86.7% and 94.3% in the preconceptional group and postconceptional group, respectively. Intraoperative blood loss in the preconceptional group was higher than that in the postconceptional group (P=0.002). There were no statistically significant differences between the two groups in the cervical cerclage time, hospital stay after MLTCC,and perioperative and long-term complications (all P>0.05). No statistical differences were found between two groups in MLTCC successful rate, cervical length in third-trimester, postoperative pregnancy and neonatal outcomes (all P>0.05). No statistical differences were found in gestational age, neonatal birth weight and cervical length in third-trimester among different MLTCC parameters (all P>0.05). Conclusion Modified laparoscopic transabdominal cervico-isthmic cerclage can effectively improve obstetric outcome in patients with cervical insufficiency. Compared with postconceptional operation, MLTCC performed preconceptionally can get similar obstetric outcome with less operative risk. It seems that double cerclage and improving stitch knots are not associated with obstetric outcomes.