经阴道宫颈环扎术治疗复发性流产合并宫颈机能不全的疗效分析

Transvaginal Cervical Cerclage for Recurrent Spontaneous Abortion with Cervical Insufficiency

摘要: 目的：评价经阴道宫颈环扎术(transvaginal cervical cerclage, TVC)对复发性流产(recurrent sponta-neous abortion, RSA)合并宫颈机能不全(cervical insufficiency, CI)患者的治疗效果。方法：选取2019年1月至2021年12月在我院接受TVC治疗合并CI的RSA患者作为研究对象，根据手术时机将其分为治疗性宫颈环扎组(80例)、紧急性宫颈环扎组(18例)及选择性宫颈环扎组(40例)，并对其临床疗效进行综合分析。结果：与紧急性宫颈环扎相比，选择性宫颈环扎和治疗性宫颈环扎至分娩间隔明显延长(35.4天 vs 105.3天；35.4天 vs 92.4天；P < 0.001)。出生体重 ≥ 2000 g新生儿比率在治疗性宫颈环扎组最高(87.5%)，其次是选择性宫颈环扎组(65.0%)和紧急性宫颈环扎组(33.3%)，差异有统计学意义(P < 0.05)。与选择性宫颈环扎组(72.22%)和紧急性宫颈环扎组(77.5%)相比，治疗性宫颈环扎组患者的活产率(95%)更高，差异有统计学意义(P < 0.05)。无论是选择性宫颈环扎组还是治疗性宫颈环扎组，相比流产次数 ≥ 3次的患者，流产次数 < 3次的患者在分娩时有更长的胎龄(P < 0.05)。在选择性宫颈环扎组中，相比孕20周后行宫颈环扎，孕20周前行宫颈环扎的患者的新生儿体重更重，分娩的孕周更大(P < 0.05；P < 0.01)。在治疗性宫颈环扎组中，相比孕20周后行宫颈环扎，在孕20周前进行宫颈环扎患者的新生儿体重更重(P < 0.01)。结论：TVC是一种有效的干预措施，可以延长合并CI的RSA患者孕周，预防早产发生，进行宫颈环扎术的最佳手术时间应在妊娠20周之前。

Abstract: Objective: To evaluate the effect of Transvaginal cervical cerclage (TVC) for Recurrent spontaneous abortion (RSA) patients with cervical insufficiency (CI). Method: RSA patients with CI treated in our hospital from January 2019 to December 2021. These patients who received TVC were categorized into emergent, elective and therapeutic groups. Results: A significant pregnancy prolongation was observed in the elective and therapeutic group (105.3 d and 92.4 d, respectively), compared with the emergent group (35.4 d, P < 0.001). Incidence of birth weight ≥ 2000 g tended to be highest in therapeutic group (87.5%), followed by the elective (65.0%) and the emergency groups (33.3%, respectively, P < 0.05). Patients in therapeutic group tended to have higher live birth rate (95%), compared with the elective and emergent group (72.22% and 77.5%, respectively, P < 0.05). Com-pared to women who had ≥ 3 abortions, those who had < 3 abortions were more likely to have long-er gestation week at delivery whether in the elective group or therapeutic group (P < 0.05). Those women in the elective group who were cerclaged before 20th gestation week could have heavier neonate weight and longer gestation week than those who were cerclaged after 20th gestation week (P < 0.05 and P < 0.01, respectively). Those women who were therapeutic cerclaged before 20th gestation week could have heavier neonate weight than the woman who were cerclaged after 20th gestation week (P < 0.01). Conclusion: TVC is an efficacious intervention that prolongs pregnancy and prevents preterm births in RSA patients with CI. The best time to do a elective cerclage is be-fore the gestional age of 20 weeks.