Bolla Daniele, Gasparri Maria Luisa, Badir Sabrina, Bajka Michael, Mueller Michael D, Papadia Andrea, Raio Luigi
Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland.
Department of Gynaecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.
Arch Gynecol Obstet. 2017 Apr;295(4):885-890. doi: 10.1007/s00404-016-4285-5. Epub 2017 Mar 3.
The aim of our study was to investigate the sonographic changes of the cervical length during pregnancy after the placement of a transvaginal cervical cerclage (TVC) or a laparoscopic abdominal cerclage (LAC) in patients with cervical insufficiency (CI).
Between January 2008 and March 2015, a retrospective analysis of all women undergoing a prophylactic laparoscopic (LAC group) or transvaginal (TVC group) cerclage due to cervical insufficiency was conducted. Nonparametric variables were analysed with the Mann-Whitney (U) test, and categorical-type outcomes were analysed with the Fisher's exact test. A p value <0.05 was considered as significant. Data analysis was performed using Prism 5 for Mac OS X.
Thirty-eight patients were included. Of these, 18 and 20 underwent an LAC and a TVC, respectively. Mean gestational age at surgery in the LAC and TVC groups was 11.4 ± 1.6 and 17 ± 3 weeks, respectively (p < 0.05). The cervical length prior to surgery was similar among the two groups. After cerclage placement, the distance between the tape and the external cervical os differed significantly between the two groups (LAC: 31.5 ± 8.8 mm vs TVC: 13.5 ± 4.9 mm; p < 0.0001) (Fig. 1). During pregnancy, the cervical length in the TVC group showed a significant shortening (from 26.6 ± 7 mm before surgery to 13.2 ± 7 mm at 33 weeks; p < 0.0001), while in the LAC group, the cervical length remained unchanged.
In patients with CI, LAC is associated with a better preservation of the cervical length throughout pregnancy as compared to TVC.
我们研究的目的是调查宫颈机能不全（CI）患者在接受经阴道宫颈环扎术（TVC）或腹腔镜下腹部环扎术（LAC）后孕期宫颈长度的超声变化。
2008年1月至2015年3月，对所有因宫颈机能不全接受预防性腹腔镜（LAC组）或经阴道（TVC组）环扎术的女性进行回顾性分析。非参数变量采用曼-惠特尼（U）检验分析，分类变量结果采用Fisher精确检验分析。p值<0.05被认为具有统计学意义。使用适用于Mac OS X的Prism 5进行数据分析。
共纳入38例患者。其中，18例和20例分别接受了LAC和TVC。LAC组和TVC组手术时的平均孕周分别为11.4±1.6周和17±3周（p<0.05）。两组术前宫颈长度相似。环扎术后，两组间宫颈带与宫颈外口的距离差异显著（LAC组：31.5±8.8mm vs TVC组：13.5±4.9mm；p<0.0001）（图1）。孕期，TVC组宫颈长度显著缩短（从术前的26.6±7mm缩短至33周时的13.2±7mm；p<0.0001），而LAC组宫颈长度保持不变。
在CI患者中，与TVC相比，LAC在整个孕期能更好地保持宫颈长度。
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