Perrotin F, Marret H, Ayeva-Derman M, Alonso A-M, Lansac J, Body G
Département de Gynécologie Obstétrique, Médecine Foetale et Reproduction Humaine, Hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours Cedex 1, France.
J Gynecol Obstet Biol Reprod (Paris). 2002 Nov;31(7):640-8.
To evaluate pregnancy outcome after therapeutic or emergency cerclage performed on the basis of clinical or/and ultrasound cervical modifications noted before 26 weeks of gestation and to precise which surgical procedure (Shirodkar or McDonald) is the most appropriate in these indications.
Retrospective study between January 1(st) 1996 and December 31(st) 2001 on 25 clinical charts of patients with suspected cervical incompetence who had second trimester cervical cerclage on the basis of clinical or ultrasound cervical length shortening. Patients with first trimester prophylactic cervical cerclage were excluded from analysis. The choice between the two surgical procedures (Shirodkar or McDonald) depended on surgeon preference but the two groups were identical for previous obstetrical history, time of cerclage and cervical modifications. Statistical analysis was performed using Chi 2 test or t-test according to the type of variables.
In our series, 9 patients had cervical cerclage performed with Shirodkar (S) procedure and 16 had McDonald cerclage (MD). Mean operating time (S: 52 +/- 18 minutes; MD: 39 +/- 3 minutes; p=0.1) and mean hospital stay (S: 5.2 +/- 1.3 days; MD: 5.3 +/- 1.5 days; p=0.9) were not significantly different between the two procedures. The difference in mean gestational age at delivery, (S: 35.7 +/- 3.2 Wks; MD: 33.2 +/- 2.9 Wks; p=0.5) and in the number of premature deliveries before 32 completed weeks (S: 22.2%; MD: 43.7%; p=0.4) better in Shirodkar group didn't reach statistical signification. No statistical difference was noted in the number of admission in neonatal intensive care unit (S: 22.2%; MD: 31.2%; p=0.9) and in neonatal survival (S: 1 neonatal death; MD: 1 neonatal death) between the two groups.
No conclusion regarding the most appropriate cervical cerclage procedure can be drawn from our study. However, Shirodkar procedure seems preferable to us due to tendency in a higher mean gestational age at delivery and because it didn't appeared to be longer or more difficult procedure. Multicentric studies may probably give better knowledge in this topic.
评估在妊娠26周前根据临床或/和超声检查发现的宫颈改变进行治疗性或紧急宫颈环扎术后的妊娠结局，并明确在这些指征下哪种手术方法（希罗德卡尔或麦克唐纳）最为合适。
对1996年1月1日至2001年12月31日期间25例疑似宫颈机能不全患者的临床病历进行回顾性研究，这些患者基于临床或超声检查发现的宫颈长度缩短在孕中期进行了宫颈环扎术。孕早期预防性宫颈环扎术患者被排除在分析之外。两种手术方法（希罗德卡尔或麦克唐纳）的选择取决于外科医生的偏好，但两组在既往产科病史、环扎时间和宫颈改变方面相同。根据变量类型使用卡方检验或t检验进行统计分析。
在我们的研究系列中，9例患者采用希罗德卡尔（S）手术进行宫颈环扎，16例采用麦克唐纳环扎（MD）。两种手术方法的平均手术时间（S：52±18分钟；MD：39±3分钟；p = 0.1）和平均住院时间（S：5.2±1.3天；MD：5.3±1.5天；p = 0.9）无显著差异。希罗德卡尔组在平均分娩孕周（S：35.7±3.2周；MD：33.2±2.9周；p = 0.5）和32周前早产数量（S：22.2%；MD：43.7%；p = 0.4）方面的优势未达到统计学意义。两组在新生儿重症监护病房住院人数（S：22.2%；MD：31.2%；p = 0.9）和新生儿存活率（S：1例新生儿死亡；MD：1例新生儿死亡）方面无统计学差异。
我们的研究无法得出关于最合适的宫颈环扎手术方法的结论。然而，由于希罗德卡尔手术在平均分娩孕周上有更高的趋势，且似乎不是更长或更困难的手术，我们认为它更可取。多中心研究可能会使我们对该主题有更好的了解。
