经阴式宫颈环扎术治疗双胎妊娠合并宫颈机能不全的研究进展
Research Progress on Transvaginal Cervical Cerclage for the Treatment of Cervical Incompetence in Twin Pregnancies
DOI: 10.12677/acm.2025.1572178, PDF,   
作者: 张嘉悦, 刘雅洁：西安医学院研究生工作部，陕西 西安；董 晋*：西北妇女儿童医院产科，陕西 西安
关键词: 宫颈环扎术；宫颈机能不全；双胎妊娠；Cervical Cerclage； Cervical Insufficiency； Twin Pregnancy
摘要: 宫颈机能不全(Cervical Incompetence, CI)以妊娠中晚期反复出现的无痛性宫颈管缩短及扩张为典型临床特征，常导致难免流产及早产。在双胎妊娠中，早产作为其最常见的并发症，导致的早产儿健康问题严重影响人口质量和健康素质。虽然经阴式宫颈环扎术作为CI的标准治疗手段已获临床共识，但其在双胎妊娠中的疗效评估仍存在较大争议。本文系统综述近年来经阴道宫颈环扎术在双胎妊娠合并CI患者中的临床应用进展，重点探讨其病因、适应证选择及术后检测等关键问题，以期为临床决策提供理论依据。
Abstract: Cervical Incompetence (CI) is typically characterized by recurrent painless shortening and dilation of the cervical canal in the middle and late stages of pregnancy, often leading to inevitable miscarriage and preterm birth. In twin pregnancies, preterm birth, as the most common complication, causes health problems in preterm infants that seriously affect the quality and health of the population. Although transvaginal cervical cerclage has gained clinical consensus as the standard treatment method for CI, there is still considerable controversy over its efficacy evaluation in twin pregnancies. This article systematically reviews the clinical application progress of transvaginal cervical cerclage in patients with twin pregnancies complicated with CI in recent years, focusing on key issues such as its etiology, indication selection, and postoperative detection, with the aim of providing a theoretical basis for clinical decision-making.
文章引用：张嘉悦, 刘雅洁, 董晋. 经阴式宫颈环扎术治疗双胎妊娠合并宫颈机能不全的研究进展[J]. 临床医学进展, 2025, 15(7): 1721-1726. https://doi.org/10.12677/acm.2025.1572178

参考文献

[1] Tan, H. (2023) The Use of Cervical Cerclage in Asymptomatic Twin Pregnancies with Cervical Shortening or Dilation: A Twelve-Year Retrospective Cohort Study. BMC Pregnancy and Childbirth, 23, Article No. 700. [Google Scholar] [CrossRef] [PubMed]
[2] Zhu, J., Huang, Y., Zeng, H., Huang, J. and Zhang, W. (2024) Pregnancy Outcomes of Twin Pregnancies with Cervical Insufficiency Undergoing Cervical Cerclage. Scientific Reports, 14, Article No. 27414. [Google Scholar] [CrossRef] [PubMed]
[3] Gökçe, A., Şükür, Y.E., Özmen, B., Sönmezer, M., Berker, B., Aytaç, R., et al. (2020) The Association between Operative Hysteroscopy Prior to Assisted Reproductive Technology and Cervical Insufficiency in Second Trimester. Archives of Gynecology and Obstetrics, 303, 1347-1352. [Google Scholar] [CrossRef] [PubMed]
[4] Stankova, T., Ganovska, A., Stoianova, M., et al. (2015) Complications of Diagnostic and Operative Hysteroscopy—A Review. Akusherstvo i ginekologiia, 54, 21-27.
[5] 夏恩兰. 《ACOG宫颈环扎术治疗宫颈机能不全指南》解读[J]. 国际妇产科学杂志, 2016, 43(6): 652-656.
[6] 娄娟, 冯敏, 顾成敏, 等. 双胎妊娠宫颈机能不全行阴道宫颈环扎对妊娠结局的影响[J]. 临床和实验医学杂志, 2020, 19(17): 1879-1882.
[7] 肖莹, 李蓉, 王永清. 多囊卵巢综合征和宫颈机能不全的相关性研究进展[J]. 医学综述, 2021, 27(19): 3908-3913.
[8] Gao, L., Zhao, Y., Wu, H., Lin, X., Guo, F., Li, J., et al. (2023) Polycystic Ovary Syndrome Fuels Cardiovascular Inflammation and Aggravates Ischemic Cardiac Injury. Circulation, 148, 1958-1973. [Google Scholar] [CrossRef] [PubMed]
[9] Jiang, L., Xiao, J., Xie, L., Zheng, F., Ge, F., Zhao, X., et al. (2025) The Emerging Roles of N6-Methyladenosine (m6A) Deregulation in Polycystic Ovary Syndrome. Journal of Ovarian Research, 18, Article No. 107. [Google Scholar] [CrossRef] [PubMed]
[10] Li, W., Li, Y., Zhao, X., Cheng, C., Burjoo, A., Yang, Y., et al. (2020) Diagnosis and Treatment of Cervical Incompetence Combined with Intrauterine Adhesions. Annals of Translational Medicine, 8, Article 54. [Google Scholar] [CrossRef] [PubMed]
[11] Shennan, A.H. and Story, L. (2022) Royal College of Obstetricians, Gynaecologists. Cervical Cerclage: Green-Top Guideline No. 75. BJOG: An International Journal of Obstetrics and Gynaecology, 129, 1178-1210.
[12] 冯敏, 王瑞华, 顾成敏, 等. 预防性宫颈环扎术治疗IVF-ET双胎妊娠合并宫颈机能不全效果[J]. 中国计划生育学杂志, 2021, 29(6): 1289-1293.
[13] Brown, R., Gagnon, R. and Delisle, M. (2019) No. 373-Cervical Insufficiency and Cervical Cerclage. Journal of Obstetrics and Gynaecology Canada, 41, 233-247. [Google Scholar] [CrossRef] [PubMed]
[14] D’Antonio, F., Eltaweel, N., Prasad, S., Flacco, M.E., Manzoli, L. and Khalil, A. (2023) Cervical Cerclage for Prevention of Preterm Birth and Adverse Perinatal Outcome in Twin Pregnancies with Short Cervical Length or Cervical Dilatation: A Systematic Review and Meta-Analysis. PLOS Medicine, 20, e1004266. [Google Scholar] [CrossRef] [PubMed]
[15] van Gils, L., Dutilh, R., Denswil, N., Roman, A., de Boer, M.A., Pajkrt, E., et al. (2025) The Effectiveness of Ultrasound-Indicated Cerclage for the Reduction of Extreme Preterm Birth in Twin Pregnancies with a Short Cervix: A Systematic Review and Meta-Analysis. American Journal of Obstetrics & Gynecology MFM, 7, Article 101555. [Google Scholar] [CrossRef] [PubMed]
[16] Houlihan, C., Poon, L.C.Y., Ciarlo, M., Kim, E., Guzman, E.R. and Nicolaides, K.H. (2016) Cervical Cerclage for Preterm Birth Prevention in Twin Gestation with Short Cervix: A Retrospective Cohort Study. Ultrasound in Obstetrics & Gynecology, 48, 752-756. [Google Scholar] [CrossRef] [PubMed]
[17] 中国妇幼保健协会宫内疾病防治专委会, 郭瑞霞, 姚书忠, 等. 子宫颈机能不全临床诊治中国专家共识(2023年版) [EB/OL].
https://xueshu.baidu.com/usercenter/paper/show?paperid=170g0x3000030pg0an450vw02k415289, 2025-05-25.
[18] Hessami, K., Kyvernitakis, I., Cozzolino, M. and Moisidis-Tesch, C. (2021) McDonald versus Shirodkar Cervical Cerclage for Prevention of Preterm Birth: A Systematic Review and Meta-Analysis of Pregnancy Outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 35, 6510-6517. [Google Scholar] [CrossRef] [PubMed]
[19] Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234. Obstetrics and Gynecology, 138, e65-e90.
[20] 陈厚运, 李维真. 不同剂量阿托西班对双胎妊娠保胎的疗效分析[J]. 长治医学院学报, 2021, 35(1): 31-34.
[21] 梅玲, 刘兴会. 宫颈环扎术后妊娠患者的孕期管理[J]. 中国实用妇科与产科杂志, 2014, 30(2): 110-112.
[22] ACOG Practice Bulletin No.142: Cerclage for the Management of Cervical Insufficiency. Obstetrics and Gynecology, 123, 372-379.
[23] Cochrane, E., Getrajdman, C., Tavella, N.F., Capi, A., Doctor, T., Rao, M.G., et al. (2024) Is There Utility in Transvaginal Cervical Length Surveillance after Cerclage Placement for the Prediction of Spontaneous Preterm Birth? Cureus, 16, e64818. [Google Scholar] [CrossRef] [PubMed]
[24] 张立鹤, 谢红宁, 郑巧, 等. E-cervix宫颈弹性成像辅助诊断非孕期宫颈机能不全的研究[J]. 中国临床新医学, 2019, 12(8): 817-821.
[25] 韩小羽, 王丽丽, 彭丽琴, 等. 宫颈弹性成像技术对宫颈机能不全孕妇保胎治疗的临床意义探讨[J]. 中国超声医学杂志, 2024, 40(10): 1126-1129.
[26] Nold, C., Anton, L., Brown, A. and Elovitz, M. (2012) Inflammation Promotes a Cytokine Response and Disrupts the Cervical Epithelial Barrier: A Possible Mechanism of Premature Cervical Remodeling and Preterm Birth. American Journal of Obstetrics and Gynecology, 206, 208.e1-208.e7. [Google Scholar] [CrossRef] [PubMed]
[27] Fang, J., Lin, Y., Chen, Z., Lin, Y. and Pan, M. (2023) The Association of Inflammatory Markers with Maternal-Neonatal Outcome after Cervical Cerclage. Journal of Inflammation Research, 16, 245-255. [Google Scholar] [CrossRef] [PubMed]
[28] Gomez, R., Romero, R., Medina, L., Nien, J.K., Chaiworapongsa, T., Carstens, M., et al. (2005) Cervicovaginal Fibronectin Improves the Prediction of Preterm Delivery Based on Sonographic Cervical Length in Patients with Preterm Uterine Contractions and Intact Membranes. American Journal of Obstetrics and Gynecology, 192, 350-359. [Google Scholar] [CrossRef] [PubMed]
[29] Esplin, M.S., Elovitz, M.A., Iams, J.D., Parker, C.B., Wapner, R.J., Grobman, W.A., et al. (2017) Predictive Accuracy of Serial Transvaginal Cervical Lengths and Quantitative Vaginal Fetal Fibronectin Levels for Spontaneous Preterm Birth among Nulliparous Women. Journal of the American Medical Association, 317, 1047-1056. [Google Scholar] [CrossRef] [PubMed]

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