治疗性宫颈环扎术临床效果及影响因素分析

发布时间：2018-01-26 05:52

  本文关键词： 治疗性宫颈环扎术 宫颈功能不全 宫缩抑制剂 早产　出处：《中国实用妇科与产科杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨治疗性宫颈环扎术的临床效果及其影响因素。方法收集2008年1月至2015年7月于北京大学第三医院接受治疗性宫颈环扎术与未接受治疗性环扎的宫颈功能不全的单胎妊娠患者132例,按孕期超声或体格检查发现的宫颈长度及宫颈内外口扩张程度进行分组。宫颈长≤2.5 cm伴宫颈内口呈V形或U形扩张,宫颈外口闭合者58例接受环扎(A组),未接受环扎23例(a组);宫颈内外口均开大,同时伴或不伴胎囊突出者39例接受环扎(B组),未接受环扎12例(b组)。B组再按宫颈外口开大程度分:B1组为1 cm≤宫颈外口开大≤3 cm(27例),B2组为3 cm宫颈外口开大≤5 cm(9例),B3组为宫颈外口开大5 cm(3例)。分析比较临床效果及与环扎效果有关的影响因素。结果 A组分娩孕周、妊娠延长天数、新生儿出生体重以及早期新生儿存活率均大于a组(P0.05);34周后及37周以后的分娩率明显增加(P0.05)。B组妊娠延长天数、分娩孕周、新生儿出生体重以及28周、32周、34周的分娩率均明显大于b组(P0.05);B组37周的分娩率大于b组(22.5%vs.0)。宫颈外口开大程度与环扎效果分析显示:环扎治疗B1组的妊娠延长天数及分娩孕周大于B2组,28周、32周及34周的分娩率明显增加(P0.05)。环扎A组保胎天数、分娩孕周、34周以后及37周后分娩率均大于环扎B1组及B2组(P0.05)。B3组3例中仅有1例早期新生儿存活。多因素线性回归分析显示:胎囊突出情况、未足月胎膜早破、宫内感染与术后保胎天数呈负相关(β分别为-20.869、-17.431、-14.963)。不同环扎孕周对分娩孕周、新生儿出生体重、早期新生儿存活率影响无统计学意义(P0.05)。结论治疗性宫颈环扎术是妊娠期宫颈明显变化的宫颈功能不全抗早产的有效补救方法;宫内感染、未足月胎膜早破以及胎囊突出情况是环扎效果的影响因素,而宫颈外口开大5 cm的环扎效果受多因素影响;手术孕周不需局限在24周内,个体化处理为宜,手术效果不受手术孕周影响。
[Abstract]:Objective to investigate the clinical effect and influencing factors of therapeutic cervix cervix ligation. Methods from January 2008 to July 2015, the therapeutic and untreated cervix cervix were performed in the third Hospital of Peking University. 132 cases of single pregnancy with cervical dysfunction. According to the length of the cervix and the degree of dilatation of the cervical orifice found by ultrasound or physical examination during pregnancy, the cervix was less than 2.5 cm long and the cervical internal orifice was V-shaped or U-shaped. The cervical external orifice closure was performed in 58 cases in group A and 23 cases in group A without ligation of cervix. 39 cases with or without fetal bursa protruding were treated with ring ligation B (n = 39). Group B was divided into 1 cm 鈮，

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