Nicolet G, Cohen M, Begue L, Reyftmann L, Boulot P, Déchaud H
Service de gynécologie-obstétrique, faculté de médecine, université Montpellier-I, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
Gynecol Obstet Fertil. 2009 Apr;37(4):294-9. doi: 10.1016/j.gyobfe.2009.02.012. Epub 2009 Apr 9.
The transabdominal cervico-isthmic cerclage could to be proposed in case of failure of vaginal cerclage, 2nd trimester fetal losses and cervical defects. The efficiency of the laparoscopic approach, more recently described, has to be demonstrated for the prevention of obstetrical accident.
This study is a retrospective monocentric evaluation of 14 laparoscopic cervico-isthmic cerclages performed with Benson modified technique before pregnancy between 2005 and 2007. Previous obstetrical accidents, etiology of cervical incompetence and patient outcome after cerclage were compared.
Median age of the patients was 33.5 years; 93% had previous fetal losses or preterm delivery and 42.9% had failure of Mac Donald cerclages. The indication of laparoscopic cervico-isthmic cerclage was Mac Donald cerclage failure (six cases), and eight cases of anatomic incompatibility of Mac Donald cerclage. Mean duration of laparoscopic cervico-isthmic cerclage was 45 minutes. All patients were hospitalized on an outpatient basis. No operative complication was reported. Six women were pregnant after cerclage: five deliveries by caesarean section at term, and one first trimester foetal loss.
The cervico-isthmic cerclage can be easily performed by laparoscopy. The indications are strictly the same as cervico-isthmic cerclages by laparotomy. Increasing the number of term deliveries and the obstetrical outcome of these patients, the efficiency of the cervico-isthmic cerclage by laparoscopy is demonstrated.
对于阴道环扎失败、孕中期胎儿丢失及宫颈缺陷的情况，可考虑行经腹宫颈峡部环扎术。最近描述的腹腔镜手术方法预防产科意外的有效性有待证实。
本研究是一项回顾性单中心评估，对2005年至2007年间在妊娠前行Benson改良技术进行的14例腹腔镜宫颈峡部环扎术进行分析。比较既往产科意外情况、宫颈机能不全的病因及环扎术后患者的结局。
患者的中位年龄为33.5岁；93%既往有胎儿丢失或早产情况，42.9%的麦克唐纳环扎术失败。腹腔镜宫颈峡部环扎术的指征为麦克唐纳环扎术失败（6例），以及8例麦克唐纳环扎术的解剖学不兼容性。腹腔镜宫颈峡部环扎术的平均时长为45分钟。所有患者均门诊住院。未报告手术并发症。6名女性环扎术后怀孕：5例足月剖宫产分娩，1例孕早期胎儿丢失。
腹腔镜可轻松施行宫颈峡部环扎术。其指征与开腹宫颈峡部环扎术完全相同。通过增加足月分娩数量及改善这些患者的产科结局，证实了腹腔镜宫颈峡部环扎术的有效性。
