宫颈环扎术在早产治疗中的应用

目的评估治疗性宫颈环扎术及预防性宫颈环扎术的效果。方法选择2003年1月至2006年3月北京大学第三医院的34周前的早产临产及宫颈机能不全患者,早产临产患者采取紧急宫颈环扎术联合宫缩抑制剂或者单纯使用宫缩抑制剂治疗。宫颈机能不全患者采取预防性宫颈环扎术、紧急环扎术以及非环扎保守治疗。对治疗结局进行统计学分析。结果在早产临产组,紧急宫颈环扎联合宫缩抑制剂（硫酸镁）来治疗早产,平均保胎天数45.00 d,较单纯用宫缩抑制剂硫酸镁抑制宫缩的34例患者保胎天数中位数为1（0.75-16）d]明显延长,34、37周后分娩率分别为66.7%（26/39）、30.8%（12/39）,明显增加。宫颈机能不全患者预防性环扎及治疗性环扎均较非环扎组保胎天数延长,增加32、34周后的分娩率（P〈0.05）,但治疗性环扎可降低早产率（P=0.02）。结论观察资料结果显示早产临产患者硫酸镁联合宫颈环扎治疗早产效果更佳,增加34周以上的分娩率,降低早产率;预防性环扎不能降低37周前早产率,但能增加32、34周后分娩率,延长保胎天数;治疗性环扎可降低37周前早产率。

Application of cervical cerclage in intervention preterm birth

Objective To analyze the effect of cervical cerclage on prevention or treatment of preterm delivery.To explore the optimal timing of a cervical cerclage procedure.Methods A total of 81 women with spontaneous preterm labor(sPTL) and 51 with cervical incompetence(CI) before their 34th gestational weeks were enrolled in this study from January 2003 to March 2006.Patients with sPTL were treated with combination of emergent cervical cerclage and tocolytic,or the sole use of tocolytic.Patients with CI were treated with preventive cervical cerclage,emergent cervical cerclage,or non-cervical cerclage treatment,while some combined with magnesium sulfate tocolytic.Results Patients with sPTL treated with combination of emergent cervical cerclage and magnesium sulfate prolonged gestation by 45 days in mean compared to 1 d(0.75~16 d) in magnesium sulfate group,and obtained delivery rate at 66.7%(26/39) after 34th week and 30.8%(12/39) after 37th week..The CI patients received cervical cerclage for both prevention and treatment increased their chances of giving birth after the 32nd and 34th week(P<0.05),while therapeutic cerclage lowered the rates of premature birth(P=0.02).Conclusions For treatment,the combination of cervical cerclage and magnesium sulfate can prevent preterm delivery.Although prophylactic cerclage does not show to decrease premature birth,it is recommended to prolong pregnancy until the 32nd and 34th week.Therapeutic cervical cerclage can also decrease the chances of premature birth.