腹腔镜下腹带扎术与经阴道宫颈环扎术治疗宫颈机能不全的比较：一项回顾性研究。
Comparison of laparoscopic abdominal cerclage and transvaginal cerclage for the treatment of cervical insufficiency: a retrospective study.
机构信息
Department of Gynecology, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266000, Shandong, China.
出版信息
Arch Gynecol Obstet. 2021 Apr;303(4):1017-1023. doi: 10.1007/s00404-020-05893-9. Epub 2020 Nov 23.
PURPOSE
To compare the pregnancy outcome of patients with cervical insufficiency (CI) underwent prophylactic laparoscopic abdominal cervical cerclage (LAC) and transvaginal cervical cerclage (TVC).
METHODS
A retrospective trial was carried out in the Department of Gynecology, Qingdao Women and Children's Hospital, Shandong Province, China. A total of 217 women with cervical insufficiency underwent the prophylactic cerclage, and the surgical approach was decided by the patients or depended on doctors' advice. The primary outcome measure was the fetal outcome. Secondary outcome measures were delivery of an infant at ≥ 34th gestational weeks, newborn birth weight, neonatal intensive care center (NICU) occupancy, and postoperative complications. Nonparametric variables were analyzed with the Mann-Whitney (U) test, and categorical type outcomes were analyzed with the Chi-square test or the Fisher's exact test. A P value < 0.05 was considered significant. Data analysis was performed using SPSS Statistics Version 19.
RESULTS
As of follow-up date, 154 eligible patients were included in this study, with 74 (48.1%) women in the LAC group and 80 (51.9%) in the TVC group. The total fetal survival rate in the two groups was 90.3% (139/154), of which the rate significantly higher in the LAC group compared to the TVC group (97.3% vs. 83.8%, P < 0.01). The delivery of an infant at ≥ 34th gestational weeks was significantly higher in the LAC group compared to the TVC group (94.6% vs. 71.3%, P < 0.01). Compared to the TVC group, the mean newborn birth weight was higher, and the NICU occupancy rate was less in the LAC group (3293.4 ± 542.8 g vs. 2953.6 ± 704.4 g, P = 0.002; 2.8% vs. 17.9%, P = 0.003).
COMPLICATIONS
No fatal surgical complications occurred in both groups.
CONCLUSION
In patients with cervical insufficiency, the history-indicated conception of prophylactic LAC appears to have a better pregnancy outcome than TVC.
目的
比较预防性腹腔镜腹式宫颈环扎术（LAC）和经阴道宫颈环扎术（TVC）治疗宫颈机能不全患者的妊娠结局。
方法
本研究为回顾性研究，在山东省青岛市妇女儿童医院妇科进行。共 217 例宫颈机能不全患者接受预防性环扎术，手术方式由患者决定或取决于医生建议。主要结局指标为胎儿结局。次要结局指标为≥34 孕周分娩的婴儿、新生儿出生体重、新生儿重症监护病房（NICU）入住率和术后并发症。非参数变量采用 Mann-Whitney（U）检验进行分析，分类变量采用卡方检验或 Fisher 确切概率法进行分析。P 值<0.05 为差异有统计学意义。数据分析采用 SPSS Statistics 版本 19。
结果
随访截止时，本研究纳入 154 例符合条件的患者，其中 LAC 组 74 例（48.1%），TVC 组 80 例（51.9%）。两组总胎儿存活率为 90.3%（139/154），其中 LAC 组明显高于 TVC 组（97.3%比 83.8%，P<0.01）。LAC 组≥34 孕周分娩的婴儿比例明显高于 TVC 组（94.6%比 71.3%，P<0.01）。与 TVC 组相比，LAC 组新生儿出生体重较高，NICU 入住率较低（3293.4±542.8 g 比 2953.6±704.4 g，P=0.002；2.8%比 17.9%，P=0.003）。
并发症
两组均无致命性手术并发症发生。
结论
对于宫颈机能不全患者，预防性 LAC 妊娠的发生似乎比 TVC 有更好的妊娠结局。
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