经阴道宫颈环扎术治疗宫颈机能不全的临床结局分析

发布时间：2018-05-07 12:02

本文选题：宫颈机能不全 + 宫颈环扎术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过回顾性研究分析孕期经阴道宫颈环扎术治疗宫颈机能不全患者的临床资料,评价经阴道宫颈环扎术的疗效;探讨宫颈机能不全孕妇的手术指证是否应该宽松,以及选择经腹、经阴环扎术的适应症。方法:1资料收集收集2010年1月到2016年9月期间就诊于河北医科大学第二医院,诊断为宫颈机能不全并行经阴道宫颈环扎术患者的病例资料,进行回顾性分析。共纳入111例病例,分析其临床资料及妊娠结局。2诊断标准孕期宫颈机能不全的诊断主要依据病史、体格检查及辅助检查,其中病史是诊断宫颈机能不全最重要的依据。根据2014年2月美国妇产科学会(The American College of Obstetricians and Gynecologists,ACOG)颁布的宫颈环扎术治疗宫颈机能不全指南文件并结合国内外相关文献,采用以下诊断标准:⑴病史:有1次及以上无痛性中孕期或晚孕期妊娠流产史或早产史,或宫颈损伤史(因宫颈病变等行手术治疗或宫颈裂伤史等);⑵阴道检查:宫颈软化,宫颈管缩短,宫颈口松弛;⑶经阴超声测量发现宫颈管短(小于25mm),宫颈内口分离,或内口扩张表现为内口楔形或漏斗样改变,怀疑宫颈机能不全者。非孕期检查证据:⑷宫颈内口通过8号Hegar扩张器;⑸子宫输卵管造影、宫腔镜检查发现宫颈机能不全。具备上述第1条标准,并符合其他4条中任何1条即确诊。入院诊断为宫颈机能不全病例共187例,后排除不符合标准者46例,失访者30例,最终111例纳入本次研究。3使用EXCEL软件建立表格,将病例资料整理并进行初步统计。应用统计软件SPSS 22.0进行统计学分析。计量数据采用均数、中位数表示;频数资料的描述用百分比(%)表示,用卡方检验(或连续性校正卡方检验)进行统计分析。P0.05为差异有统计学意义。结果:111例病例中,行宫颈环扎术时最小年龄20岁,最大年龄39岁,平均年龄28.65岁,中位年龄28岁;宫颈环扎术时最小孕次2次,最大孕次8次,有1次孕中晚期流产史者22例,2次者46例,3次及以上者43例,平均妊娠次数3.52次,中位妊娠次数3次;宫颈环扎术时最小孕周12+1周,最大孕周24+3周,平均孕周16.11周,中位孕周15+4周。成功分娩96例,流产15例,成功率为86.49%。成功分娩96例患者的分娩方式:剖宫产49例(51%),顺产47例(49%);流产的15例均经阴道娩出。结论:1宫颈机能不全的诊断及手术指证尚需进一步规范。在掌握合适手术指征时,宫颈环扎术是宫颈机能不全安全、有效的治疗手段。2宫颈机能不全的手术指证应该宽松。3宫颈环扎术的术式选择:年轻、生育能力好者可首选经阴道宫颈环扎术;高龄、珍贵儿、经阴手术困难、不适合经阴道宫颈环扎术甚至因不孕症行辅助生殖者可首选腹腔镜子宫峡部环扎术。
[Abstract]:Objective: to analyze retrospectively the clinical data of transvaginal cervix ligation in the treatment of cervical insufficiency during pregnancy, to evaluate the curative effect of transvaginal cervix ligation, and to explore whether the surgical indication of pregnant women with cervical insufficiency should be loose. The indications of transabdominal and transvaginal ring ligation were also selected. Methods the data collected from January 2010 to September 2016 in the second Hospital of Hebei Medical University, diagnosed as cervical insufficiency and transvaginal cervix ligation, were analyzed retrospectively. The clinical data and pregnancy outcome of 111 cases were analyzed. The diagnosis of cervical insufficiency during pregnancy was mainly based on the history, physical examination and auxiliary examination, in which the history was the most important basis for the diagnosis of cervical insufficiency. According to the American College of Obstetricians and Gynecologists ACOG issued by the American Society of Obstetrics and Gynecology in February 2014, the guidelines for the treatment of cervix insufficiency by cervix cervicitis were published in February 2014 and combined with the relevant literature at home and abroad. Use the following diagnostic criteria: 1 or more history of painless or late pregnancy, abortion or premature delivery, or history of cervical injury (surgical treatment due to cervical lesions, history of cervical laceration, etc.) vaginal examination: cervicomalacia, The short cervical canal (less than 25mm), the separation of cervical internal orifice, or the dilatation of the inner orifice showed wedge-shaped or funnel-like changes in the cervical canal, and the patients with suspected cervical insufficiency were found to be short (< 25mm) by transvaginal sonography. Evidence of non-pregnancy examination:: 4 uterine salpingography via 8 Hegar dilator, hysteroscopy revealed cervical dysfunction. Meets the above Article 1 criteria and meets any one of the other 4 criteria. 187 cases were diagnosed as cervical insufficiency, 46 cases were excluded and 30 cases were lost. Finally, 111 cases were included in this study using EXCEL software to set up a table, the data of the cases were sorted out and preliminary statistics were made. Statistical software SPSS 22. 0 was used for statistical analysis. The measurement data were expressed by the mean, the median; the frequency data were described by percentage), and the statistical analysis by chi-square test (or continuity calibration chi-square test) was statistically significant. Results among 111 cases, the minimum age was 20 years old, the maximum age was 39 years, the average age was 28.65 years, the median age was 28 years, and the minimum pregnancy time was 2 times, the maximum pregnancy time was 8 times. There were 22 cases with a history of 1 term miscarriage, 46 cases with 3 or more pregnancies, the average number of pregnancies was 3.52 and the median pregnancy was 3 times, the minimum gestational week was 121 weeks, the maximum gestational week was 24 3 weeks, and the average gestational week was 16.11 weeks, the average gestational age was 16. 11 weeks, the minimum gestational age was 121 weeks, the maximum gestational age was 24 3 weeks and the average gestational week was 16. 11 weeks. The median gestational age was 154 weeks. There were 96 cases of successful delivery and 15 cases of abortion, the success rate was 86.49%. The delivery patterns of 96 cases of successful delivery were as follows: 49 cases of cesarean section 49 cases of cesarean section 47 cases of spontaneous delivery and 15 cases of abortion were delivered through vagina. Conclusion the diagnosis and operation of cervix malfunction should be further standardized. Cervical ring ligation is a safe and effective treatment for cervical insufficiency. 2. The operative indication of cervical insufficiency should be loosely adjusted. 3. The choice of operation method for cervical ligation is: young, young, young, young, young, young, young, young, young, young, young, young, young, young, young, young, young, and young. Transvaginal cervix ligation is the first choice for those with good fertility, and for the elderly, precious children, difficult transvaginal operation, it is not suitable for transvaginal cervix ligation or even laparoscopic uterine isthmus ligation for assisted reproduction due to infertility.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713

【参考文献】