经阴道宫颈环扎术与腹腔镜下腹膜宫颈环扎术治疗宫颈机能不全的比较：来自单一中心的回顾性研究。
Comparison of transvaginal cervical cerclage versus laparoscopic abdominal cervical cerclage in cervical insufficiency: a retrospective study from a single centre.
机构信息
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
出版信息
BMC Pregnancy Childbirth. 2022 Oct 17;22(1):773. doi: 10.1186/s12884-022-05108-w.
BACKGROUND
Cervical cerclage has been proposed as an effective treatment for cervical insufficiency, but there has been controversy regarding the surgical options of cervical cerclage in singleton and twin pregnancies. This study aimed to compare the pregnancy outcomes between transvaginal cervical cerclage (TVC) and laparoscopic abdominal cervical cerclage (LAC) in patients with cervical insufficiency. We also aimed to evaluate the efficacy and safety, and provide more evidence to support the application of cervical cerclage in twin pregnancies.
METHODS
A retrospective study was carried out from January 2015 to December 2021. The primary outcomes were the incidence of spontaneous preterm birth (sPTB) < 24 weeks, < 28, < 32, < 34 weeks, and < 37weeks, gestational age at delivery, and the incidence of admission for threatened abortion or preterm birth after cervical cerclage. The secondary outcomes included admission to the Neonatal Intensive Care Unit, adverse neonatal outcomes and neonatal death. We also analysed the pregnancy outcomes of twin pregnancies after cervical cerclage.
RESULTS
A total of 289 patients were identified as eligible for inclusion. The LAC group (n = 56) had a very low incidence of sPTB ˂ 34 weeks, and it was associated with a significant decrease in sPTB < 28 weeks, ˂32 weeks, ˂34 and < 37 weeks, and admission to the hospital during pregnancy for threatened abortion or preterm birth after cervical cerclage (0 vs.27%; 1.8% vs. 40.3%; 7.1% vs. 46.8%; 14% vs. 63.5%, 8.9% vs. 62.2%, respectively; P < 0.001), and high in gestational age at delivery compared with the TVC group (n = 233) (38.3 weeks vs.34.4 weeks,P < 0.001). Neonatal outcomes in the LAC group were significantly better than those in the TVC group. The mean gestational age at delivery was 34.3 ± 1.8 weeks, with a total foetal survival rate of 100% without serious neonatal complications in twin pregnancies with LAC.
CONCLUSION
In patients with cervical insufficiency, LAC appears to have better pregnancy outcomes than TVC. For some patients, LAC is a recommended option and may be selected as the first choice. Even in twin pregnancies, cervical cerclage can improve pregnancy outcomes with a longer latency period, especially in the LAC group.
背景
宫颈环扎术已被提议作为治疗宫颈功能不全的有效方法，但在单胎和双胎妊娠中宫颈环扎术的手术选择存在争议。本研究旨在比较经阴道宫颈环扎术（TVC）和腹腔镜下腹膜宫颈环扎术（LAC）在宫颈功能不全患者中的妊娠结局。我们还旨在评估疗效和安全性，并提供更多证据支持宫颈环扎术在双胎妊娠中的应用。
方法
进行了一项回顾性研究，时间为 2015 年 1 月至 2021 年 12 月。主要结局是自发性早产（sPTB）<24 周、<28 周、<32 周、<34 周和<37 周的发生率、分娩时的胎龄以及宫颈环扎术后因先兆流产或早产入院的发生率。次要结局包括入住新生儿重症监护病房、不良新生儿结局和新生儿死亡。我们还分析了宫颈环扎术后双胎妊娠的妊娠结局。
结果
共确定 289 名符合纳入标准的患者。LAC 组（n=56）sPTB<34 周的发生率极低，且与 sPTB<28 周、<32 周、<34 周和<37 周以及宫颈环扎术后因先兆流产或早产入院的发生率显著降低有关（0%比 27%；1.8%比 40.3%；7.1%比 46.8%；14%比 63.5%；8.9%比 62.2%，分别；P<0.001），并且与 TVC 组（n=233）相比，分娩时的胎龄更高（38.3 周比 34.4 周，P<0.001）。LAC 组的新生儿结局明显优于 TVC 组。平均分娩时的胎龄为 34.3±1.8 周，LAC 组的双胎妊娠总胎儿存活率为 100%，无严重新生儿并发症。
结论
在宫颈功能不全患者中，LAC 的妊娠结局似乎优于 TVC。对于某些患者，LAC 是一种推荐的选择，并且可以作为首选。即使在双胎妊娠中，宫颈环扎术也可以通过延长潜伏期来改善妊娠结局，尤其是在 LAC 组。
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