宫颈锥切及根治性宫颈切除术后宫颈环扎问题

宫颈部分切除术治疗宫颈上皮内瘤变，可有效降低宫颈浸润癌的发病率，根治性宫颈切除术治疗早期宫颈癌，可有效降低宫颈浸润癌的病死率。但是这两种术式均可能导致手术后宫颈机能不全。宫颈锥切术切除了部分宫颈组织，降低了宫颈承托力，引起晚期流产和早产，影响妊娠预后。宫颈环扎能够延长宫颈长度，显著降低术后因宫颈机能不全导致的早产和复发性中期妊娠流产的发生。因此，对有生育要求的患者需要进行预防性或治疗性的宫颈环扎术。为预防根治性宫颈切除术导致的宫颈机能不全，手术中常规采用不可吸收性缝合线行永久性宫颈环扎，但是术后仍有因宫颈问题发生中期妊娠流产或早产者。宫颈缝合术（trachelorraphy）是一种安全、可重复、易于掌握的操作，以预防宫颈环扎失败而再次发生的流产，有利于改善有不良产科病史者的围生期结局。

Cervical Cerclage after Cervical Conisation and Radical Trachelectomy

Cervical intraepithelial neoplasia treated by partial resection of cervix can effectively reduce the incidence of cervical invasive carcinoma.Early cervical carcinoma treated by radical trachelectomy can significantly reduce the mortality of cervical invasive carcinoma.However,these two types of operation are likely to lead to cervical insufficiency after surgery.Partial resection of cervix reduces the cervical supporting capacity due to the removed cervical tissue,which results in late abortion and premature delivery,and influences the reproductive outcome.Cervical cerclage can prolong the cervical length,and reduce the rates of premature delivery and midtrimester abortion.Therefore,the patients with fertility requirements need the preventive or therapeutic cervical cerclage.In order to prevent the cervical insufficiency caused by the radical trachelectomy,permanent cervical cerclage was performed with non-absorbable suture routinely.However,the second-trimester miscarriage or premature delivery is still encountered after surgery.Trachelorraphy is a safe,repeatable and easy to perform operation,to prevent the failed cervical cerclage.It is benefit to improve reproductive outcome for those women with the cervical insufficiency related to radical trachelectomy.