Lee Kyong-No, Park So-Yoon, Son Ga-Hyun, Lee Keun-Young
Department of Obstetrics and Gynecology, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Front Surg. 2025 Jun 13;12:1484120. doi: 10.3389/fsurg.2025.1484120. eCollection 2025.
Despite evidence of adverse pregnancy outcomes associated with adenomyosis, there are no established strategies for risk assessment, stratification, or prevention of these potential complications. This study aimed to describe and evaluate the technique of adenomyomectomy with preconceptional transabdominal cervicoisthmic cerclage (TCIC) in high-risk women with an unfavorable history of previous preterm birth and/or second trimester miscarriage after transvaginal cerclage.
Eligible patients had adenomyosis, confirmed by ultrasound or biopsy, and a history of second trimester miscarriages or preterm deliveries before 28 weeks despite transvaginal cerclage. All patients underwent adenomyomectomy followed by preconceptional placement of TCIC. Their obstetric and gynecologic histories, surgical outcomes, and pregnancy courses were retrospectively reviewed. Of the 85 patients who underwent this procedure at our facility over a 10-year period, we report the outcomes of 17 patients with antenatal care and delivery records available at our hospital.
Seventeen patients were included in the final analysis. Only one patient delivered before 34 weeks, and six between 34 and 37 weeks. One patient had three successful pregnancies following the procedure.
Adenomyomectomy with preconceptional TCIC may be a viable treatment option for patients with adenomyosis who wish to have a successful pregnancy after a previous preterm delivery or miscarriage.
尽管有证据表明子宫腺肌病与不良妊娠结局相关，但对于这些潜在并发症的风险评估、分层或预防，尚无既定策略。本研究旨在描述和评估在有既往早产和/或经阴道宫颈环扎术后孕中期流产不良病史的高危女性中，孕前经腹宫颈峡部环扎术（TCIC）联合子宫腺肌病切除术的技术。
符合条件的患者经超声或活检确诊为子宫腺肌病，且尽管接受了经阴道宫颈环扎术，但仍有孕中期流产或28周前早产史。所有患者均接受子宫腺肌病切除术，随后进行孕前TCIC放置。对她们的妇产科病史、手术结局和妊娠过程进行回顾性分析。在我们机构10年间接受该手术的85例患者中，我们报告了17例在我院有产前检查和分娩记录患者的结局。
17例患者纳入最终分析。仅1例患者在34周前分娩，6例在34至37周之间分娩。1例患者术后有3次成功妊娠。
对于既往有早产或流产史且希望成功妊娠的子宫腺肌病患者，孕前TCIC联合子宫腺肌病切除术可能是一种可行的治疗选择。
