Wei M L, Yang Y, Jin X Y, Yang J Y, Huang D, Zhang S Y
Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310016, China.
Zhonghua Yi Xue Za Zhi. 2020 Oct 13;100(37):2913-2918. doi: 10.3760/cma.j.cn112137-20200509-01469.
To explore the surgical opportunity of the transvaginal cervicoisthmic cerclage in the treatment of the cervical incompetence and the effect on the pregnancy outcomes. A Retrospective controlled trial was carried out between January 2014 and December 2018 in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China and a total of 1 027 patients with cervical incompetence underwent the transvaginal cerclage. According to the different surgical opportunity, the patients were divided into two groups: the conception cerclage (=736) and the preconception cerclage (=291), and the former were divided into two subgroups depending on the condition of the cervix, the history indicated conception cerclage (=511) and the ultrasound indicated conception cerclage (=225). Main outcome measures were the gestational age, term delivery rate, the fetal weight and the fetal survival rate. After the cerclage, the gestational age was (36±4) weeks, the term delivery rate was 69.6% (710/1 020), the fetal weight was (3 038±624)g and the fetal survival rate was 94.7% (966/1 020). Compared with the ultrasound indicated conception cerclage subgroup, the gestational age, the term delivery rate, and the fetal weight were all significantly higher in the history indicated conception cerclage subgroup [(37±4) vs (36±5) weeks, =2.691; 72.8% vs 62.7%,χ(2)=7.593; (3 091±594) vs (2 963±756) g, =2.396; all <0.05], but the fetal survival rate was comparable in these two groups(95.3% vs 92.9%, χ(2)=1.772, >0.05). There were no significant differences in the gestational age, the term delivery rate, the fetal weight and fetal survival rate between the history indicated conception cerclage and the preconception cerclage (all >0.05). The transvaginal cervicoisthmic cerclage is a promising and safe technique for improving obstetric outcomes in women with cervical incompetence, and the history indicated conception cerclage is better than the ultrasound indicated cerclage.
探讨经阴道宫颈峡部环扎术治疗宫颈机能不全的手术时机及其对妊娠结局的影响。2014年1月至2018年12月在中国浙江邵逸夫医院妇产科进行了一项回顾性对照试验，共有1027例宫颈机能不全患者接受了经阴道环扎术。根据手术时机不同，将患者分为两组：孕期环扎组（n = 736）和孕前环扎组（n = 291），前者又根据宫颈情况分为两个亚组，即病史提示孕期环扎组（n = 511）和超声提示孕期环扎组（n = 225）。主要观察指标为孕周、足月分娩率、胎儿体重和胎儿存活率。环扎术后，孕周为（36±4）周，足月分娩率为69.6%（710/1020），胎儿体重为（3038±624）g，胎儿存活率为94.7%（966/1020）。与超声提示孕期环扎亚组相比，病史提示孕期环扎亚组的孕周、足月分娩率和胎儿体重均显著更高[（37±4）周 vs （36±5）周，t = 2.691；72.8% vs 62.7%，χ² = 7.593；（3091±594）g vs （2963±756）g，t = 2.396；均P < 0.05]，但两组胎儿存活率相当（95.3% vs 92.9%，χ² = 1.772，P > 0.05）。病史提示孕期环扎组与孕前环扎组在孕周、足月分娩率、胎儿体重和胎儿存活率方面均无显著差异（均P > 0.05）。经阴道宫颈峡部环扎术是改善宫颈机能不全女性产科结局的一种有前景且安全的技术，病史提示孕期环扎优于超声提示环扎。
