腹腔镜下宫颈环扎术治疗宫颈机能不全16例临床分析

目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。

Laparoscopic cervical cerclage in the management of cervical incompetence-analysis of 16 cases

ObjectiveTo investigate the safety and efficacy of laparoscopic cerclage in the management of cervical incompetence.MethodsLaparoscopic cerclage was performed for 16 women with cervical incompetence.The pregnancy results were observed after laparoscopic cerclage.ResultsLaparoscopic cerclage was performed uneventfully for 16 women with no conversion to laparotomy.10 patients get pregnancy after surgery.5 patients have not conceived due to the short interval after surgery.One women surfer from infertility after surgery for one year.9 of 10 women have cesarean section to deliver the baby.8 women has term pregnancy and 1 women has a gestation age of 31 weeks.An average gestation age was 20 weeks gestation before surgery and 37.9 weeks after surgery in the 9 patients with the extention of 17.9 weeks gestation.one patient has preterm rupture of membrane which result in inevitable abortion at 20 weeks gestation.The Mersilene tape was cut through laparotomy and the fetus was expelled vaginally.ConclusionLaparoscopic cerclage can prolong the gestation age and increase the full term pregnancy rate.It is a safe and effective method in the management of cervical competence.