本文選題：孕前環(huán)扎 + 孕期環(huán)扎　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的比較孕前及孕期經(jīng)陰道子宮峽部環(huán)扎術(shù)治療宮頸機(jī)能不全的臨床療效。方法此次臨床對照研究納入了 2017年2月之前在浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院就診的具有反復(fù)孕中期流產(chǎn)病史的宮頸機(jī)能不全患者,共62名患者。根據(jù)手術(shù)方式將其分為孕前環(huán)扎組及孕期環(huán)扎組。主要觀察指標(biāo)是37周妊娠率、34周妊娠率、活產(chǎn)率。次要觀察指標(biāo)包括手術(shù)時間、術(shù)中出血、手術(shù)并發(fā)癥、28周妊娠率、分娩孕周、新生兒體重、新生兒并發(fā)癥。結(jié)果①此次研究共82人符合初篩標(biāo)準(zhǔn),其中孕前環(huán)扎組39人,孕期環(huán)扎組43人。孕前環(huán)扎組中有6人處于妊娠狀態(tài),3人失訪,余30人已有妊娠結(jié)局。孕期環(huán)扎組中10人處于妊娠狀態(tài),1人失訪,余32人已有妊娠結(jié)局。最終將有妊娠結(jié)局的62名患者納入統(tǒng)計,包括孕前環(huán)扎組30人和孕期環(huán)扎組32人。②兩組患者之間的年齡,體重指數(shù),既往孕中期流產(chǎn)史,既往宮腔操作史,宮頸手術(shù)史,8號擴(kuò)棒通過情況,妊娠方式,既往不孕史均未見明顯差異(P0.05),孕前環(huán)扎組和孕期環(huán)扎組的術(shù)前閉合宮頸陰道段長度分別為29.16±2.76mm和33.18±4.76mm。孕前環(huán)扎組中自然妊娠患者的平均備孕時間為3.20月,孕期環(huán)扎組的平均手術(shù)孕周為孕15周。③根據(jù)磁共振檢查及腹腔鏡術(shù)中所見,經(jīng)陰道子宮峽部環(huán)扎術(shù)的環(huán)扎線高度達(dá)子宮峽部水平。④孕前環(huán)扎手術(shù)時間明顯長于孕期環(huán)扎(69.40±24.85vs51.41±12.06分;P=0.001)。孕前環(huán)扎和孕期環(huán)扎組的術(shù)中出血也有統(tǒng)計學(xué)差異(20.17±34.53 vs 43.75±33.96ml;P=0.009)。62例手術(shù)均順利進(jìn)行,僅孕期環(huán)扎組的1名患者出現(xiàn)了術(shù)后環(huán)扎部位滲血。余均未出現(xiàn)宮頸裂傷、胎膜早破、圍手術(shù)期感染等并發(fā)癥。孕前環(huán)扎及孕期環(huán)扎組的術(shù)中評估宮頸陰道段長度未見明顯差異(12.60±5.26vs13.31±5.56mm;P0.05)。而孕期環(huán)扎的抗生素使用時間(3.66±1.13 vs 2.57±0.50 天;P0.001)和住院天數(shù)(9.84±5.43 vs 4.00±0.74天;P0.001)明顯長于孕前環(huán)扎組。⑤妊娠結(jié)局方面,孕前環(huán)扎組的37周妊娠率為24/30(80.0%),34周妊娠率為29/30(96.7%),28周妊娠率為30/30(100.0%),活產(chǎn)率30/30(100%),平均分娩孕周為37.43±1.59周,平均新生兒體重為3163.33±516.03克;孕期環(huán)扎組37周妊娠率為31/32(96.9%),34周妊娠率為 32/32(100.0%),28 周妊娠率為 32/32(100%),活產(chǎn)率 32/32(100%),平均分娩孕周為38.09±1.09周,平均新生兒體重為3373.44±314.43克,兩組在統(tǒng)計學(xué)上未顯示明顯差異(P0.05)。孕前環(huán)扎組中出現(xiàn)1例高膽紅素血癥,孕期環(huán)扎組出現(xiàn)2例胎糞吸入綜合征和3例高膽紅素血癥,余未見膿毒血癥、壞死性小腸炎、顱內(nèi)出血等新生兒并發(fā)癥。兩組間的剖宮產(chǎn)率(86.7%vs 87.5%;P0.05)和新生兒 NICU 天數(shù)(1.57±4.26vs0.81±2.13 天;P0.05)未見明顯差異。結(jié)論①改良經(jīng)陰道子宮峽部環(huán)扎術(shù),可以在不開腹、不打開Douglas窩的情況下達(dá)到子宮峽部的環(huán)扎高度。②經(jīng)陰道子宮峽部環(huán)扎術(shù)因其療效確切,操作簡單,安全可靠等優(yōu)勢,有較大的臨床應(yīng)用前景。但孕前經(jīng)陰道子宮峽部環(huán)扎術(shù)與孕期環(huán)扎相比,妊娠結(jié)局未見明顯差異。③該研究的樣本量有限,需要進(jìn)行更多高質(zhì)量的臨床試驗來指導(dǎo)宮頸環(huán)扎的臨床應(yīng)用。
[Abstract]:Objective to compare the clinical efficacy of transvaginal isthmus cerclage in the treatment of cervical incompetence before and during pregnancy. Methods the clinical control study was included in 62 patients with a history of repeated mid-term abortion in the Sir Run Run Shaw Hospital of the Zhejiang University medical college before February 2017. The main observation indexes were 37 weeks pregnancy rate, 34 week pregnancy rate and live rate. The secondary observation indexes included operation time, intraoperative bleeding, surgical complications, 28 weeks pregnancy rate, pregnancy week, newborn weight, neonatal complications. Results 1. The results of this study were in line with the initial screening criteria, prepregnancy before pregnancy. There were 39 in the ring group and 43 in the pregnancy group. 6 of them were in pregnancy, 3 were lost and 30 had pregnancy outcomes. 10 of them were in pregnancy, 1 were lost, and 32 had pregnancy outcomes. In the end, 62 patients with pregnancy outcomes included 30 pregnant cerclage group and 32 pregnant ring group. (2) the age, body mass index, the history of past mid-term abortion, the history of previous uterine cavity operation, the history of cervical surgery, the passage of No. 8, pregnancy and previous infertility had no significant difference (P0.05). The preoperative closed cervical and vaginal segment length was 29.16 + 2.76mm and 33.18 + 4.76mm. respectively. The average time of pregnancy for the patients with natural pregnancy was 3.20 months in the anterior cerclage group, and the average operative week for the cerclage group was 15 weeks. (3) the cerclage line of the transvaginal isthmus cerclage reached the level of the uterine isthmus according to the magnetic resonance examination and laparoscopy. (4) the time of pre pregnancy ring fixation was longer than that of pregnancy (69.40 + 24.85vs5). 1.41 + 12.06 points; P=0.001). There were also significant differences in intraoperative bleeding between prenatal cerclage and pregnancy ligation group (20.17 + 34.53 vs 43.75 + 33.96ml; P=0.009).62 cases were carried out smoothly. Only 1 patients in the group of pregnant cerclage group had postoperative ligation of blood. No complications of cervical laceration, premature rupture of membranes, perioperative infection and other complications. There was no significant difference in the length of cervical and vaginal segment (12.60 + 5.26vs13.31 + 5.56mm; P0.05) in the anterior cerclage group and pregnant cerclage group, and the use of antibiotics in pregnancy (3.66 + 1.13 vs 2.57 + 0.50 days, P0.001) and the days of hospitalization (9.84 + 5.43 vs 4 + 0.74 days; P0.001) were significantly longer than that in the pre pregnancy ligation group. The 37 week pregnancy rate in the ring group was 24/30 (80%), the 34 week pregnancy rate was 29/30 (96.7%), the 28 week pregnancy rate was 30/30 (100%), the survival rate was 30/30 (100%), the average birth rate was 37.43 + 1.59 weeks, the average newborn weight was 3163.33 + 516.03 grams. The pregnancy rate in the pregnancy cycle group was 31/32 (96.9%) and the pregnancy rate was 32/32. 32/32 (100%), the survival rate of 32/32 (100%), the average birth pregnancy week was 38.09 + 1.09 weeks, the average weight of the newborn was 3373.44 + 314.43 grams, the two groups did not show significant difference (P0.05). There were 1 hyperbilirubinemia in the pre pregnancy ring group, 2 cases of meconium aspiration syndrome and 3 hyperbilirubinemia in the pregnancy cerclage group, and no sepsis. The cesarean section rate (86.7%vs 87.5%; P0.05) and the number of NICU days in the newborn (1.57 + 4.26vs0.81 + 2.13 days; P0.05) were not significantly different between the two groups. Conclusion (1) the improved transvaginal uterine isthmus cerclage can reach the isthmus of the uterine isthmus without opening the abdomen and opening the Douglas nest. The transvaginal uterine isthmus cerclage has the advantages of definite curative effect, simple operation, safe and reliable and so on. But there is no significant difference in pregnancy outcome between prepregnancy vaginal isthmus cerclage and cerclage during pregnancy. 3. The sample size of this study is limited, and more high quality clinical trials are needed. To guide the clinical application of cervix cerclage.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.2
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本文編號：1922563