本文選題：宮頸機能不全 + 宮頸環(huán)扎術(shù)�。� 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過回顧性研究分析孕期經(jīng)陰道宮頸環(huán)扎術(shù)治療宮頸機能不全患者的臨床資料,評價經(jīng)陰道宮頸環(huán)扎術(shù)的療效;探討宮頸機能不全孕婦的手術(shù)指證是否應(yīng)該寬松,以及選擇經(jīng)腹、經(jīng)陰環(huán)扎術(shù)的適應(yīng)癥。方法:1資料收集收集2010年1月到2016年9月期間就診于河北醫(yī)科大學第二醫(yī)院,診斷為宮頸機能不全并行經(jīng)陰道宮頸環(huán)扎術(shù)患者的病例資料,進行回顧性分析。共納入111例病例,分析其臨床資料及妊娠結(jié)局。2診斷標準孕期宮頸機能不全的診斷主要依據(jù)病史、體格檢查及輔助檢查,其中病史是診斷宮頸機能不全最重要的依據(jù)。根據(jù)2014年2月美國婦產(chǎn)科學會(The American College of Obstetricians and Gynecologists,ACOG)頒布的宮頸環(huán)扎術(shù)治療宮頸機能不全指南文件并結(jié)合國內(nèi)外相關(guān)文獻,采用以下診斷標準:⑴病史:有1次及以上無痛性中孕期或晚孕期妊娠流產(chǎn)史或早產(chǎn)史,或?qū)m頸損傷史(因?qū)m頸病變等行手術(shù)治療或?qū)m頸裂傷史等);⑵陰道檢查:宮頸軟化,宮頸管縮短,宮頸口松弛;⑶經(jīng)陰超聲測量發(fā)現(xiàn)宮頸管短(小于25mm),宮頸內(nèi)口分離,或內(nèi)口擴張表現(xiàn)為內(nèi)口楔形或漏斗樣改變,懷疑宮頸機能不全者。非孕期檢查證據(jù):⑷宮頸內(nèi)口通過8號Hegar擴張器;⑸子宮輸卵管造影、宮腔鏡檢查發(fā)現(xiàn)宮頸機能不全。具備上述第1條標準,并符合其他4條中任何1條即確診。入院診斷為宮頸機能不全病例共187例,后排除不符合標準者46例,失訪者30例,最終111例納入本次研究。3使用EXCEL軟件建立表格,將病例資料整理并進行初步統(tǒng)計。應(yīng)用統(tǒng)計軟件SPSS 22.0進行統(tǒng)計學分析。計量數(shù)據(jù)采用均數(shù)、中位數(shù)表示;頻數(shù)資料的描述用百分比(%)表示,用卡方檢驗(或連續(xù)性校正卡方檢驗)進行統(tǒng)計分析。P0.05為差異有統(tǒng)計學意義。結(jié)果:111例病例中,行宮頸環(huán)扎術(shù)時最小年齡20歲,最大年齡39歲,平均年齡28.65歲,中位年齡28歲;宮頸環(huán)扎術(shù)時最小孕次2次,最大孕次8次,有1次孕中晚期流產(chǎn)史者22例,2次者46例,3次及以上者43例,平均妊娠次數(shù)3.52次,中位妊娠次數(shù)3次;宮頸環(huán)扎術(shù)時最小孕周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,流產(chǎn)15例,成功率為86.49%。成功分娩96例患者的分娩方式:剖宮產(chǎn)49例(51%),順產(chǎn)47例(49%);流產(chǎn)的15例均經(jīng)陰道娩出。結(jié)論:1宮頸機能不全的診斷及手術(shù)指證尚需進一步規(guī)范。在掌握合適手術(shù)指征時,宮頸環(huán)扎術(shù)是宮頸機能不全安全、有效的治療手段。2宮頸機能不全的手術(shù)指證應(yīng)該寬松。3宮頸環(huán)扎術(shù)的術(shù)式選擇:年輕、生育能力好者可首選經(jīng)陰道宮頸環(huán)扎術(shù);高齡、珍貴兒、經(jīng)陰手術(shù)困難、不適合經(jīng)陰道宮頸環(huán)扎術(shù)甚至因不孕癥行輔助生殖者可首選腹腔鏡子宮峽部環(huán)扎術(shù)。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R713

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