宫颈机能不全的经阴道超声诊断价值评价

目的:评价经阴道超声检查对宫颈机能不全的诊断价值。方法:分析25例宫颈机能不全患者非孕期及孕16~18周宫颈长度并与同时期健康孕妇相对照。结果:CIC患者非孕期宫颈长度及孕1~18周的宫颈长度低于均健康对照组。结论:经阴道超声检查宫颈长度对评估CIC具有一定价值。     

超声监测妊娠期宫颈成熟度的临床价值

目的　应用超声显像监测妊娠期宫颈成熟度 ,探讨其在妊娠期的变化规律。方法　经腹部、会阴及阴道超声检查观察妊娠期宫颈 117例 ,比较其成功率及准确性。结果　阴道超声显像成功率达 10 0 % ,显著高于会阴及腹部超声 ,宫颈长度测值则较腹部及会阴短 (P <0 .0 1)。正常妊娠期 ,阴道超声宫颈长度测值 :中孕期 ( 33.6± 3.6mm) ;晚孕期 ( 32 .1± 4.2mm) ;足月未临产者 ( 2 6.3± 4.9mm)。结论　阴道超声宫颈显像成功率及准确性高于腹部、会阴超声 ;宫颈管长度在孕 2 8～ 37周相对恒定 ,孕 38周后逐渐缩短 ,其长度与临产时间十分相关     

研究孕期经阴道宫颈环扎术治疗宫颈机能不全

目的:研究孕期经阴道宫颈环扎术治疗宫颈机能不全的临床疗效。方法:选择本院在2018年4月至2019年4月收治的50例宫颈机能不全患者进行临床研究,针对这些患者均使用经阴道宫颈环扎术进行治疗,观察患者临床效果,主要包括阴道分娩、剖宫产、早产、死亡、手术成功、胎儿成活等方面。结果:50例患者手术成功率为96.00%,胎儿存活率为90.00%。结论:患者妊娠是否能够成功,与宫颈长度存在紧密联系。当妇女怀孕13~18周之后,对于宫颈机能不全的患者,为其实施宫颈环扎术进行治疗,能够有效帮助患者延长孕周,并且能够进一步增加胎儿的存活率。     

经会阴彩色多普勒超声对宫颈机能不全的诊断价值

目的:探究会阴彩色多普勒超声对宫颈机能不全的诊断效果。方法:本研究抽取于我院进行诊断的宫颈机能不全患者共计22例作为本次研究的对象,诊治时间为2017年1月~2019年5月。对研究对象进行分组,分组原则采取随机数表法,分为对照组和观察组,每组各11例。对照组患者采取腹部超声检查,观察组患者采取经会阴区彩色多普勒超声检查,观察两组患者的宫颈机能不全的检出率、宫颈内口、外口的成像满意率以及对比两组患者诊断宫颈机能不全的孕周。结果:观察组患者超声的检出率为100.00%,对照组患者超声的检出率为63.64%,观察组的检出率更高,高出36.36%,差异有统计学意义,P<0.05;观察组患者超声的成像满意率为81.82%(宫颈外口)和72.73%(宫颈内口);对照组患者的超声成像满意率为27.27%(宫颈外口)和27.27%(宫颈内口),观察组患者超声的成像满意率更高,差异具有统计学意义,P<0.05;观察组患者诊断出宫颈机能不全的孕周为(21.23±0.45)w,对照组患者为(24.16±0.61)w,差异具有统计学意义,P<0.05。结论:经会阴彩色多普勒超声对宫颈机能不全的诊断效果显著,检出率更高,成像效果更好,值得临床大力推广应用。     

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

目的研究阴道宫颈环扎治疗双胎妊娠宫颈机能不全的效果及对妊娠结局的影响。方法采用回顾性研究方法,选择2015年1月至2020年1月秦皇岛市妇幼保健院收治的50例单胎妊娠宫颈机能不全患者与50例双胎妊娠宫颈机能不全患者,分别设定为对照组与研究组,两组均选用经阴道宫颈环扎术治疗,比较两组患者的手术指标、妊娠情况及妊娠结局。结果研究组术中出血量、手术时间、住院时间、术后延长妊娠孕周、终止妊娠孕周、5 min新生儿Apgar评分、新生儿存活率、新生儿体重、足月产率、早产率及流产率依次为(19.32±3.17) ml、(36.71±2.15) min、(3.74±0.57) d、(18.53±1.92)周、(36.84±1.83)周、(7.73±0.38)分、86.00%、(3.02±0.67) kg、58.00%、26.00%、16.00%,对照组依次为(20.08±2.96) ml、(36.95±1.97) min、(3.58±0.55) d、(21.47±1.83)周、(38.39±1.81)周、(9.15±0.42)分、98.00%、(3.51±0.73) kg、78.00%、14.00%、4.00%。两组手术指标(术中出血量、手术及住院时间)、早产率比较,差异无统计学意义(P0.05);研究组较对照组术后延长妊娠孕周、终止妊娠孕周更短,新生儿Apgar评分、新生儿存活率、新生儿体重及足月产率更低,流产率更高,差异均具有统计学意义(P 0.05)。结论双胎妊娠宫颈机能不全行阴道宫颈环扎术治疗的效果良好,但较单胎妊娠宫颈机能不全疗效较差,临床治疗应根据患者实际情况谨慎使用阴道宫颈环扎术。     

腹腔镜下宫颈环扎术在宫颈机能不全治疗中的应用及时机选择

目的 探讨腹腔镜下宫颈环扎术在宫颈机能不全(CI)治疗中的临床疗效以及手术时机的选择。方法 回顾性分析2019年6月—2022年12月在苏北人民医院就诊的120例CI患者的临床资料。根据孕期及手术方式的不同,将患者分为孕前腹腔镜组(n=45)、孕早期腹腔镜组(n=42)和经阴道组(n=33,经阴道宫颈环扎术)。记录患者的住院时间、手术时间、术中出血量以及孕期保胎率等指标。随访收集患者的妊娠情况,分析3组患者的妊娠结局,总结不同孕期阶段的手术选择原则。结果 孕前腹腔镜组和孕早期腹腔镜组术中出血量、住院时间和孕期保胎率均低于经阴道组,差异有统计学意义(P<0.01); 3组在手术时间方面比较,差异均无统计学意义(P>0.05)。与经阴道组相比,孕前腹腔镜组和孕早期腹腔镜组流产率和早产率降低,足月产率以及分娩孕周提高,差异均有统计学意义(P<0.05)。孕前腹腔镜组相较于孕早期腹腔镜组有较低的早产率,差异有统计学意义(P=0.044)。结论 腹腔镜宫颈环扎术可有效改善CI患者的妊娠结局,提高足月产率以及分娩孕周,降低流产率及早产率。孕前腹腔镜宫颈环扎术在降低早产率以及手术风...     

经腹及经阴道彩超辅助临床诊断宫颈机能不全孕妇的价值对比

目的:对比分析经腹部彩超和经阴道彩超辅助临床诊断宫颈机能不全孕妇的价值。方法:将我院2020年11月至2021年11月收治的50例疑似宫颈机能不全孕妇纳为本次研究对象,50例孕妇均先行问诊、妇科检查和超声检查,再行经腹部超声检查(经腹组)和经阴道超声检查(经阴道组),对比分析两组的诊断价值。结果:经阴道组宫颈内口显示率、宫颈外口显示率、羊膜囊嵌入宫颈内程度显示率均高于经腹组(P<0.05)。两组宫颈长度<2cm、宫颈管内径>6mm、宫颈内有羊膜囊嵌入影像的检出率差异有统计学意义(P<0.05)。50例孕妇经综合判断为宫颈机能不全者有37例,经阴道彩超检查诊断宫颈机能不全的灵敏度、特异度、准确率、阳性预测值、阴性预测值均较高。结论:经阴道彩超检查诊断宫颈机能不全孕妇,与经腹部彩超相比,宫颈内口、宫颈外口以及羊膜囊嵌入宫颈内程度显示率与检出率更高,诊断价值也更高。     

妊娠中期宫颈机能不全实施经阴道宫颈环扎术的干预效果评价

目的 评价妊娠中期宫颈机能不全实施经阴道宫颈环扎术的干预效果。方法 选取2021年1月—2022年12月长春市妇产医院收治的116例妊娠中期宫颈机能不全患者为研究对象,根据患者意愿分为对照组(58例,保守治疗)和观察组(58例,经阴道宫颈环扎术)。对比两组患者的妊娠结局和新生儿结局。结果 观察组延长孕周、分娩孕周长于对照组,差异有统计学意义(P<0.05)。观察组流产率为17.24%,低于对照组,观察组足月分娩率为34.48%,高于对照组,差异有统计学意义(χ²=9.206、24.166,P<0.05)。观察组新生儿出生体质量、Apgar评分高于对照组,差异有统计学意义(P<0.05)。观察组新生儿呼吸窘迫综合征发生率为0,低于对照组的21.21%,差异有统计学意义(χ²=8.620,P<0.05)。观察组新生儿缺氧缺血性脑病发生率、病死率与对照组比较,差异无统计学意义(P>0.05)。结论 妊娠中期宫颈机能不全实施经阴道宫颈环扎术的干预效果明确,能有效延长妊娠时间,降低围生儿的病死率,从而改善妊娠结局。     

预防性宫颈环扎术和紧急性宫颈环扎术治疗宫颈机能不全患者的临床疗效及安全性比较

目的 对比紧急性宫颈环扎术与预防性宫颈环扎术治疗宫颈机能不全的临床疗效。方法 以回顾性分析为法,观察对象为2021年1月至2022年6月入海南医学院第一附属医院的100例宫颈机能不全患者,参考手术时机分为研究组(n=50)与对照组(n=50),研究组行预防性宫颈环扎术治疗,对照组行紧急性宫颈环扎术治疗。比较两组患者的手术相关指标(术中出血量、手术时间、住院时间)、分娩情况(妊娠32周宫颈长度、分娩孕周、妊娠延长时间)、分娩结局(剖宫产、自然分娩)、妊娠结局(足月产率、早产率、流产率)及并发症(胎膜早破、产后出血、宫颈裂伤)发生情况。结果 两组患者手术时间比较差异无统计学意义(P>0.05);研究组患者术中出血量为(30.18±5.33) mL,明显低于对照组[(42.17±5.71) mL],住院时间为(6.81±2.74) d,明显短于对照组[(9.04±2.63) d],差异均有统计学意义(P<0.05)。研究组患者妊娠32周宫颈长度、分娩孕周、妊娠延长时间分别为(2.98±0.32) cm、(37.49±3.97)周、(9.82±2.47)周,均明显长于对照组[(2....     

宫颈机能不全7例的超声诊断

目的 探讨超声检查对宫颈机能不全的诊断价值。方法 对经超声及手术证实的7例宫颈机能不全患者的资料作回顾性分析,7例患者均进行经腹部及经会阴超声检查宫颈管情况。结果 7例患者均符合宫颈机能不全诊断标准。宫颈内口呈“Y”形者2例,功能性宫颈长度20~25mm,宫颈漏斗比例均为27%;呈“V”形者1例,功能性宫颈长度11mm,宫颈漏斗比例为66%;呈“U”形者4例,功能性宫颈长度均<10 mm,宫颈漏斗比例为72%~83%。7例孕妇均行宫颈环扎术至足月分娩,无一例早产。结论 超声测量宫颈长度对宫颈机能不全的诊断准确性高,实用性强,且简便、直观、易行、可重复性强。 更多还原     

三维能量多普勒超声成像技术在早期宫颈癌血管检测中的应用

目的探讨三维能量多普勒超声定量检测早期宫颈癌肿块内血管的诊断价值及早期宫颈癌肿瘤体积与血管参数(VI、FI、VFI)的相关性。方法对25例临床诊断为早期宫颈癌(Ia～IIa期)的患者(宫颈癌组)及19例宫颈上皮内瘤变(CIN)Ⅱ～Ⅲ级的患者(宫颈上皮内瘤变组)行三维能量多普勒超声检查,测定宫颈或肿块内血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)3项血管参数,同时观察宫颈癌组患者肿瘤体积与血管参数的相关性,并与20例正常女性(对照组)宫颈的3项血管参数检测值进行比较。结果早期宫颈癌组[VI(5.44±4.02)%、FI(41.61±3.51)及VFI(2.31±1.65)]3项血管参数平均测值明显高于宫颈上皮内瘤变组[VI(1.84±0.62)%、FI(39.17±4.12)、VFI(1.34±0.55)]和对照组[VI(0.77±0.11)%、FI(38.49±3.55)及VFI(0.47±0.33)],差异有统计学意义(P0.05);宫颈上皮内瘤变组2项血管参数测值VI、VFI亦高于对照组,差异有统计学意义(P0.05)。早期宫颈癌组患者宫颈肿瘤体积越大,宫颈肿瘤内FI测值也升高,宫颈肿瘤体积与FI测值间存在线性正相关关系,相关系数r=0.523(P=0.007)。结论三维能量多普勒超声是定量检测早期宫颈癌肿块内血流的新方法,可为早期宫颈癌患者超声检查提供更多诊断信息。     

Cervical length evaluation by transvaginal sonography in nongravid women with a history of preterm delivery.

OBJECTIVE: To evaluate cervical length in the nongravid period in women with a past history of preterm delivery. METHODS: The study population comprised 54 women who had delivered spontaneously before 34 weeks of gestation. Etiology of preterm delivery was suspected to be related to cervical incompetence, defined as a painless and progressive dilatation of the cervix in the absence of other causes. Patients with pre-eclampsia, intrauterine growth restriction, uterine anomalies, fetal anomalies, multiple gestation and similar complications were excluded. Shortening of the cervix was recorded during pregnancy in all study patients. One hundred and four women matched for age, parity and body mass index who had given birth at term served as the control group. Cervical length was evaluated in all women at least 12 weeks after delivery by transvaginal sonography in the mid-sagittal plane. RESULTS: The mean gestational age at delivery was 30.8 +/- 1.2 weeks in the study group and 38.8 +/- 2.1 weeks in the control group (P = 0.03). The mean cervical length in the two groups was 36 +/- 6 and 38 +/- 4 mm, respectively. This difference was not statistically significant (P = 0.9). CONCLUSIONS: In nongravid women with unexplained preterm delivery there is no difference in cervical length compared to patients who deliver at term. Shortening of the cervix is most probably a reversible phenomenon that occurs during pregnancy and represents a failure of the competence mechanism to adapt to pregnancy.     

Transvaginal sonographic evaluation of cervix length after cervical conization.

OBJECTIVE: The purpose of this study was to evaluate transvaginal sonographic cervical length before and after cervical conization for squamous intraepithelial lesions. METHODS: Between November 2002 and October 2004, all women undergoing conization by either cold-knife conization or a loop electrosurgical excision procedure for squamous intraepithelial lesions were prospectively enrolled in this study. Cervical length was measured by transvaginal sonography (TVS) before and after conization. RESULTS: A total of 48 women were studied before and after a mean of 7 days after conization. Complete excision was achieved in 41 patients, and endocervical margins were involved in 7 patients. Mean TVS cervical length was significantly shorter after than before conization (mean +/- SD, 22.7 +/- 6.9 versus 26.7 +/- 8.1 mm; P < .001). The correlation coefficient between cone specimen length and postoperative length was r = 0.75 (P < .001). Mean TVS cervical lengths were 24.3 +/- 6.7 mm in the group of women who underwent a loop electrosurgical excision procedure and 20.7 +/- 9.4 mm in the group of women who underwent cold-knife conization (P = .13). CONCLUSIONS: Transvaginal sonographic measurement of cervical length after conization is well correlated with cone specimen length.     

Cervical incompetence: the use of transvaginal sonography to provide an objective diagnosis.

OBJECTIVE: To investigate the use of transvaginal sonography in monitoring the cervix in women at high risk of a preterm delivery. STUDY DESIGN: One hundred and six women at high risk of preterm labor had regular cervical monitoring by transvaginal ultrasound throughout pregnancy from the second trimester to delivery. The study was designed to be observational, but intervention was considered if the cervical length fell below 10 mm. RESULTS: Eleven women demonstrated opening of the cervical canal at rest or with fundal pressure before 24 weeks' gestation. Between 2 and 17 days later all 11 cervices progressively shortened to a cervical length of < 10 mm. Nine women had a cervical cerclage. Seven women had fetal membranes visible within the cervical canal at the time of cerclage. One woman miscarried at 18 weeks, and the other 10 had live births at a median gestational age of 36 (range, 27-38) weeks. CONCLUSIONS: Cervical length shortening in the second trimester, once started, progressed to a cervical length under 10 mm. Opening of the cervical os at rest or in response to fundal pressure detected by transvaginal ultrasound appears to be the early ultrasound feature of cervical incompetence.     

非脱垂子宫经阴道全子宫切除术探讨

目的 探讨非脱垂子宫经阴道全子宫切除术的临床效果.方法 将100例行子宫全切术的子宫及宫颈良性病变患者按随机数字表法分为2组,每组50例.TVH组采用经阴道全子宫切除术(TVH)治疗,TAH组采用经腹全子宫切除术(TAH)治疗,对2组术中、术后的情况进行比较.结果 TVH组的手术时间和术中出血量分别为(90.0±19.5)min和(162.8±69.5)Ml,TAH组的手术时间及术中出血量分别为(122.4±19.6)min和(245.5±70.6)Ml,2组手术时间和术中出血量比较差异均有统计学意义(均P＜0.01).TVH组术后进食、排气、下床活动时间早,术后病率小、疼痛轻、住院时间短,明显优于TAH组(P＜0.05或P＜0.01).结论 TVH具有创伤小、术后恢复快、住院时间短的优点,是一种理想的子宫切除手术.     

Serial translabial sonographic measurement of cervical dimensions between 24 and 34 weeks' gestation in pregnant Thai women.

OBJECTIVE: To assess serial changes of cervical dimensions in pregnant Thai women between 24 and 34 weeks' gestation by translabial sonography. METHODS: A longitudinal study of cervical dimensions obtained by translabial sonography at 24, 28, 30, 32, and 34 weeks' gestation in 144 women was conducted. The gestational age at labor was recorded and women were defined as having preterm labor or term labor according to whether there was onset of true labor pain before or after 37 completed weeks, respectively. Cervical changes over time were analyzed by repeated ANOVA. The associations between cervical dimensions and gestational age, parity and prepregnancy body mass index were calculated by multiple linear regression analysis. RESULTS: Cervical length decreased whereas cervical width increased as gestational age advanced. Cervical length and width in women with term labor, but only cervical length in women with preterm labor, changed significantly throughout the period of 24-34 weeks' gestation (P < 0.01). The cervix was significantly longer in parous women and in women with a body mass index of more than 26 kg/m2, but was shorter in women of advanced gestational age. The cervix was significantly wider in parous women and in those of advanced gestational age. Weekly crude rate, adjusted for parity and prepregnancy body mass index, of both cervical length shortening and cervical width widening was 0.4 mm in women with term labor. Women with preterm labor had cervical shortening of 0.5 mm per week. CONCLUSIONS: Gestational age, parity and prepregnancy body mass index are significantly associated with the dynamic changes of cervical length and width in Thai women. These factors should be considered when assessing normal values of cervical dimensions and for predicting the risk of preterm delivery.     

宫颈微小偏离性腺癌临床病理分析（附8例报告）

目的：探讨宫颈微小偏离性腺癌的诊断与治疗。方法：按照WHO（2003）宫颈腺癌分类标准,回顾性分析我院收治的8例宫颈微小偏离性腺癌的临床病理资料。结果：宫颈微小偏离性腺癌占同期收治宫颈浸润腺癌的4．73％,临床表现为水样白带和／或生殖道出血、宫颈肥大变硬和赘生物,阴道B超检查示宫腔积液,宫颈细胞学诊断较困难,常需深部活检组织诊断。结论：诊断应结合临床表现,影像学检查,宫颈细胞学。当高度怀疑时应取深部组织或宫颈锥切组织诊断,早期诊治预后较好。     

Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length.

OBJECTIVE: To compare the effects of therapeutic cerclage and bed rest vs. just bed rest on cervical length and to relate these effects to the risk of preterm delivery. DESIGN: Cervical length was measured in patients at high risk of cervical incompetence. When a cervical length < 25 mm was measured before 27 weeks' gestation, randomization for therapeutic cerclage and bed rest vs. just bed rest was performed. After randomization, cervical length was measured weekly. For statistical analysis, t-test and Fisher's exact tests were used and P < 0.05 was considered statistically significant. RESULTS: Nineteen women were randomly allocated to receive a therapeutic cerclage and bed rest and 16 were allocated to receive bed rest only. Mean cervical lengths and mean gestational ages before randomization were comparable between both groups, overall 19.8 mm and 20.7 weeks. Cervical length was measured again at a mean gestation of 22.1 weeks. Mean cervical length (31 mm) was significantly (P < 0.0001) longer after cerclage than after bed rest only (19 mm). A cervical length > or = 25 mm was measured in 22 of the 35 included women, 16 in the cerclage group and six in the bed-rest group (P = 0.006). Of these 22 women, only one delivered before 34 weeks' gestation, which was significantly less frequent than six out of 13 women with a cervical length < 25 mm (P = 0.006). CONCLUSIONS: Therapeutic cerclage with bed rest increases cervical length more often than bed rest alone. A postintervention cervical length > or = 25 mm reduces the risk of preterm delivery in women at high risk of cervical incompetence and a preintervention cervical length < 25 mm.     

Cervical assessment at the routine 23-week scan: standardizing techniques.

OBJECTIVE: To examine the frequency of curvature of the cervix and to establish the degree of curvature with increasing cervical length. To assess the significance of this phenomenon in terms of the classification of patients as high risk for pre-term delivery. METHOD: Cervical length was measured prospectively by transvaginal sonography in 301 women at 23 weeks of gestation. The distance between the internal and external os was measured both as a straight line and also as a curved line along the endocervical canal. In addition, a search of our database was made to identify all women who had undergone cervical assessment as part of a policy of routine screening. In those with cervical length of less than 26 mm the thermal images of the cervix were used to obtain straight and curved measurements. The frequency of curved cervix was calculated and the relationship between the ratio of straight to curved measurement to the curved one was determined. RESULTS: In the prospective study curvature of the cervix was observed in 143 (48%) of the 301 women. Curvature was observed in 51% (135 of 267) with cervical length of 26-55 mm, 25% (8 of 32) with length of 16-25 mm, and none of the two with length of 1-15 mm. The ratio of the straight to the curved measurement decreased with increasing cervical length (r = -0.27, P = 0.001). In the retrospective study curvature of the cervix was found in 72 (15%) of 471 with length of 16-25 mm and in none of the 76 with length of 1-15 mm. CONCLUSION: Cervical length is influenced by the degree of cervical curvature. The disparity of measurements between the internal and external os taken as a straight line or along the cervical canal increases with cervical length. However, this disparity may not have any clinical implications because at short cervical length (less than 16 mm) the cervix appears to be always straight.     

多次宫颈环扎术治疗宫颈机能不全的疗效观察

目的:评价多次宫颈环扎术治疗宫颈机能不全的疗效。方法:回顾性分析行单次或多次宫颈环扎术51例的临床资料。结果:(1)多次宫颈环扎术组(A组)的手术成功率明显高于单次宫颈环扎术组(B组)(78.6%vs 38.5%,P0.05);与B组相比,A组终止妊娠的天数、延长妊娠天数及新生儿体重明显增加(248.0±26.9 vs 186.6±54.7)d;(129.9±49.9 vs 55.7±45.6)d;(2527.3+916.3 vs 1289.2+1238.8)g,P均0.05。(2)术后住院组的手术成功率与术后出院组无明显差异(P0.05)。结论:多次宫颈环扎术的疗效优于单次宫颈环扎术,能明显延长孕周及增加新生儿体重:术后住院并不能增加手术成功率。