不同手术路径对有指征行宫颈环扎术孕妇妊娠结局的影响。
Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage.
机构信息
Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China.
出版信息
Arch Gynecol Obstet. 2024 Apr;309(4):1377-1386. doi: 10.1007/s00404-023-07007-7. Epub 2023 Apr 1.
OBJECTIVE
To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome.
METHODS
A total of 53 cases by laparoscopic abdominal cervical cerclage (LAC group) before pregnancy and 73 cases by transvaginal cervix cerclage (TVC group) at 12-14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. Furthermore, the gestational weeks after cervical cerclage were compared between the two groups with high- and low-risk grades.
RESULTS
The number of previous uterine cavity operations in LAC group was more than that TVC group, and the costs of operation were more than TVC group. At the same time, the hospitalization days and operation time were longer than those in TVC group, and the delivery rate of cesarean section was higher than TVC group, but the total hospitalization times were less than TVC group (P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in LAC group were lower than those in TVC group (P < 0.05). In TVC group, the increased number of prior PTB or STL and the history of cervical cerclage failure would increase the risk of premature delivery before 34 weeks of pregnancy. There was no increased risk of preterm delivery before 34 weeks of pregnancy in LAC group (P > 0.05). According to the risk level, in the high-risk group, the delivery rate of LAC group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of TVC group.
CONCLUSION
Laparoscopic cervical cerclage might be more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks was not affected by related medical history. For high-risk patients with the history of prior PTB or STL and failed cerclage, laparoscopic cervical cerclage might be more effective than vaginal cervical cerclage in preventing extremely preterm before 28 weeks, premature delivery before 34 weeks and premature delivery before 37 weeks. Therefore, our limited experience suggested that LAC can be a recommended option for patients with high-risk history.
目的
研究病史对宫颈机能不全腹腔镜和阴道宫颈环扎术治疗的指导意义及其对妊娠结局的影响。
方法
收集 53 例孕前腹腔镜腹式宫颈环扎术（LAC 组）和 73 例 12-14 周经阴道宫颈环扎术（TVC 组）患者的临床资料。对影响分娩孕周的因素进行多因素 logistic 回归分析。进一步比较两组中高危和低危患者宫颈环扎术后的孕周。
结果
LAC 组既往宫腔操作次数多于 TVC 组，手术费用多于 TVC 组，同时住院天数和手术时间长于 TVC 组，剖宫产率高于 TVC 组，但总住院时间短于 TVC 组（P<0.05）。LAC 组早产<34 周的发生率和胎膜早破或早产的发生率低于 TVC 组（P<0.05）。在 TVC 组中，增加的既往 PTB 或 STL 次数和宫颈环扎术失败史会增加早产<34 周的风险，LAC 组早产<34 周的风险没有增加（P>0.05）。根据风险水平，高危组 LAC 组在<37 周、<34 周和<28 周的分娩率低于 TVC 组。
结论
腹腔镜宫颈环扎术可能更有效地预防 34 周前早产，且其对分娩孕周的影响不受相关病史的影响。对于既往有 PTB 或 STL 病史且环扎术失败的高危患者，腹腔镜宫颈环扎术可能比阴道宫颈环扎术更有效地预防 28 周前极早产、34 周前早产和 37 周前早产。因此，我们有限的经验表明，LAC 可以作为有高危病史患者的一种推荐选择。
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