择期宫颈环扎术联合间苯三酚治疗宫颈机能不全对孕妇妊娠结局和新生儿的影响

吴国荧 鲁顺琼 王斌

[摘要]目的 探討择期宫颈环扎术联合间苯三酚治疗宫颈机能不全（CIC）对孕妇妊娠结局和新生儿的影响。方法 选取2015年1月～2018年6月我科收治的45例CIC孕妇作为研究对象，根据随机数字表法分为对照组（22例）与观察组（23例）。对照组采用期待疗法，观察组采用择期宫颈环扎术联合间苯三酚，两组孕妇均随访至妊娠结束。比较两组的新生儿预后、妊娠结局。将观察组孕妇根据手术时期分为A组（孕12～16周手术，13例）与B组（孕>16～24周手术，10例），比较两组的新生儿预后及妊娠结局。结果 观察组新生儿存活率、出生体重、出生5 min Apgar评分高于对照组，新生儿窒息率低于对照组，差异有统计学意义（P<0.05）;观察组分娩孕龄、足月产率高于对照组，流产率、早产率低于对照组，差异有统计学意义（P<0.05）;A组足月产率高于B组，早产率低于B组，差异有统计学意义（P<0.05）。结论 择期宫颈环扎术联合间苯三酚治疗CIC患者可延长孕龄，有效地改善新生儿预后及妊娠结局，孕早期手术疗效更好。

[关键词]宫颈环扎术;间苯三酚;宫颈机能不全;新生儿预后;妊娠结局

[Abstract] Objective To investigate the effect of selective cervical cerclage combined with Phloroglucinol on pregnancy outcome and neonatal outcome of pregnant women with cervical insufficiency （CIC）. Methods A total of 45 pregnant women with CIC admitted to our department from January 2015 to June 2018 were selected as the subjects， and divided into control group （n=22） and observation group （n=23） by random number table method. The control group used expectant therapy， and the observation group were given selective cervical cerclage combined with Phloroglucinol， the two groups were all followed up until the end of pregnancy. The neonatal prognosis and pregnancy outcomes were compared between the two groups. According to the period of operation， the pregnant women of observation group were divided into group A （12-16 weeks of gestation， 13 cases） and group B （more than 16 to 24 weeks of gestation， 10 cases）. The neonatal prognosis and pregnancy outcomes were compared between the two groups. Results The neonatal survival rate， birth weight and 5 min Apgar score in the observation group were higher than those in the control group， and the asphyxia rate was lower than that in the control group， the differences were statistically significant （P<0.05）. The gestational week and full-term rate of delivery in the observation group were higher than those in the control group， and the abortion rate and premature delivery rate were lower than those in the control group， the differences were statistically significant （P<0.05）. The full-term rate of group A was higher than that of group B， while the premature rate was lower than that of group B， the differences were statistically significant （P<0.05）. Conclusion Selective cervical cerclage combined with Phloroglucinol can prolong the gestational age of CIC patients， effectively improve the prognosis and pregnancy outcomes of neonates， and the effect of early pregnancy surgery is better.

[Key words] Cervical cerclage; Phloroglucinol; Cervical insufficiency; Neonatal prognosis; Pregnancy outcome

综上所述，择期宫颈环扎术联合间苯三酚治疗CIC可延长孕龄，有效改善新生儿预后以及妊娠结局，孕早期行宫颈环扎术的疗效可能更好。

[参考文献]

[1]Lamont CD，Jorgensen JS，Lamont RF.The safety of tocolytics used for the inhibition of preternlabour[J].Expert Opin Dnlg Saf，2016，15（9）：1163-1173.

[2]蔡慧清，聂超凤.宫颈环扎术治疗宫颈机能不全导致的复发性流产临床分析[J].当代医学，2017，19（22）：96-97.

[3]Naqvi M，BaahwH Jr.Emergency cerclage：outcomes，patient selection，and operative considerations[J].Clin Obstet Gynecol，2016，59（2）：286-294.

[4]王秋明，武海英，党群.紧急宫颈环扎术联合阿托西班在宫颈机能不全治疗中的临床价值[J].国际生殖健康/计划生育杂志，2017，36（5）：392-395.

[5]蒋玉蓉，游一平，唐雅兵.紧急宫颈环扎术联合网片补丁缝合治疗宫颈机能不全32例临床分析[J].实用妇产科杂志，2017，33（4）：307-310.

[6]张兴威，梁雨，吕荣君.紧急宫颈环扎术治疗宫颈机能不全所致孕中晚期流产及早产的临床分析[J].中国妇幼保健，2017，32（23）：5967-5969.

[7]李妍，李娜.不同孕周和不同治疗时机行宫颈环扎术治疗宫颈机能不全的效果及对妊娠结局的影响[J].中国妇幼保健，2017，32（18）：4557-4559.

[8]霍雷，張秀丽，陈银凤.预防性宫颈环扎术治疗宫颈机能不全疗效观察[J].海南医学，2017，28（7）：1082-1084.

[9]丁佳佳，赵恩锋.孕中期宫颈机能不全行宫颈环扎术的临床疗效及手术时机探究[J].中国煤炭工业医学杂志，2015， 18（1）：73-75.

[10]沈庆君，王蕴慧，刘颖琳，等.67例紧急宫颈环扎术疗效及影响因素分析[J].实用妇产科杂志，2014，30（4）：270-273.

[11]Ciancimino L，Laganà AS，Imbesi G，et al.Evaluation of maternal-fetal outcomes after emergency vaginal cerclage performed with Shirodkar-McDonald combined modified technique[J].J Clin Med Res，2015，7（5）：319-323.

[12]Bourgioti C，Chatoupis K，Moulopoulos LA.Current imaging strategies for the evaluation of uterine cervical cancer[J].World J Radiel，2016，8（4）：342-354.

[13]张梦莹，时春艳.宫颈机能不全的诊治进展[J].中华围产医学杂志，2016，19（7）：548-551.

[14]郭燕子，何锋云.腹腔镜下宫颈环扎术对宫颈机能不全患者的治疗效果及对妊娠结局的影响[J].医学综述，2016， 22（14）：2869-2871.

[15]邱晓芬，王巧玲，倪明军.妊娠期宫颈机能不全行宫颈环扎术的手术时机探究[J].黑龙江医学，2016，40（1）：16-17.

（收稿日期：2019-09-11  本文编辑：闫  佩）