宫颈环扎术的过去、现状和将来

宫颈机能不全是中晚期流产和早产的重要原因,其特点是无痛性宫颈扩张,通常不伴有子宫收缩和出血。多年来,宫颈环扎术是治疗宫颈机能不全的有效方法,本文聚焦宫颈环扎术,讨论宫颈环扎术的诊断、适应证、禁忌证、外科手术入路(经阴道,腹腔镜或开腹手术)、环扎手术时机(孕前或孕期环扎)、手术方式、技术的选择、缝线的正确放置位置、药物辅助治疗(如孕激素和抗生素)和宫颈环扎带的移除。腹腔镜宫颈环扎术的应用日益广泛,最近报道宫颈环扎术不必为了放置环扎带而分离下推膀胱,而是直接在子宫峡部进行环扎(极简式腹腔镜宫颈环扎术),这使术式的学习更容易、学习曲线更短,这一术式有深远的影响,将在不久的将来得到更为广泛的应用。

The Past,Present and Future of Cervical Cerclage

Cervical incompetence, an important cause of mid-trimester loss or preterm birth, is characterized by painless cervical dilation in the absence of uterine contractions or bleeding. Cervical cerclage has been used for many years to treat cervical incompetence. This review will focus on a number of practical issues relating to cervical cerclage, namely, diagnosis , indications,contraindications for cervical cerclage, choosing the surgical approach (vaginal, laparoscopy and laparotomy), deciding when to do it (before or during pregnancy), finding out if the suture has been correctly placed, and considering when to use medical adjuvant therapy such as progesterone and antibiotics and when to removal of cervical suture. Laparoscopic cervical cerclage is becoming increasingly popular especially as a recent report suggested that it is no longer necessary to dissect the bladder away from the lower segment of the uterus in order to insert the cervical cerclage (simplified laparoscopic cervical suture). It means that learning how to perform the procedure is easier, with a shorter learning curve. The finding has far reaching implications and will undoubtedly change clinical practice in the near future.