“经阴道拆除式”腹腔镜下宫颈环扎术13例临床分析

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英文篇名：The clinical research of 13 patients operated by the modified laparoscopic transabdominal cervical cerclage with removable transvaginal tape 作者：高蕾 ; 王祎祎 ; 贾宗洋 ; 褚然 ; 靳艳慧 ; 张向宁 英文作者：Gao Lei;Wang Yiyi;Jia Zongyang;Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University;Department of Gynecology Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University; 关键词：宫颈机能不全 ; 腹腔镜下宫颈环扎术 ; 经阴道分娩 英文关键词：Cervical incompetence;;Laparoscopic transabdominal cervical cerclage;;Transvaginal delivery 中文刊名：现代妇产科进展 英文刊名：Progress in Obstetrics and Gynecology 机构：山东大学齐鲁医院妇产科;首都医科大学附属北京妇产医院微创中心;山东大学齐鲁医院(青岛)妇产科; 出版日期：2019-03-21 13:13 出版单位：现代妇产科进展 年：2019 期：06 语种：中文; 页：10-14+18 页数：6 CN：37-1211/R ISSN：1004-7379 分类号：R713.4

摘要

目的:探讨"经阴道拆除式"腹腔镜下宫颈环扎术(MLTCC)的临床可行性及其优势。方法:收集2012年4月至2018年12月在山东大学齐鲁医院行腹腔镜下宫颈环扎术(LTCC)的90例患者的临床资料和手术视频。按手术方式分为传统腹腔镜下宫颈环扎术组(TLTCC组,77例)和MLTCC组(13例),回顾分析两组患者的基本临床特征、手术相关指标、术后妊娠情况、分娩方式和新生儿情况,采用卡方检验、非参数秩和检验对数据统计分析。结果:与TLTCC组相比,MLTCC组的单纯宫颈环扎时间明显缩短[18min(12～30min) vs 21min(9～50min),P=0.04],术后妊娠分娩的剖宫产率显著降低(0%vs 100%,P<0.001)。两组的手术总时间、术中出血总量、单纯宫颈环扎出血量、白细胞计数、中性粒细胞比例、住院总天数、术后住院天数、单纯行LTCC的住院费用、止痛药物使用、围术期并发症、环扎带与周围组织重度粘连发生率、妊娠期并发症、妊娠期保胎治疗率、分娩孕周比较,差异均无统计学意义(P>0.05)。结论:MLTCC保留了传统腹腔镜下宫颈环扎术的优点,缩短了宫颈环扎的手术时间,降低了因环扎术所致的剖宫产分娩率。
        Objective:To evaluate the efficiency and the safety of the modified laparoscopic transabdominal cervical cerclage with removable transvaginal tape.Methods:Seventy-seven women operated with the TLTCC between Apr.2012 and Dec.2018 in our department(TLTCC group).Thirteen women were operated with the MLTCC during the same time window were selected as comparison group(MLTCC group).The difference of clinical characteristic,perioperative data,postoperative obstertric outcomes,mode of delivery between MLTCC group and TLTCC group were analyzed by using nonparametric rank sum test and chi-square test.Results:Compared to the TLTCC group,the MLTCC group had shorter cerclage operation time(P=0.04) and lower cesarean section rate after the cerclage(P<0.001).There were no significant differences in the total operation time,intraoperative blood loss,postoperative pain,total hospitalization days and hospitalization days after operation,hospitalization expense of LTCC,perioperative complications,tape adhesion,complications during pregnancy,abortion treatment during pregnancy,gestational weeks of pregnancy.Conclusion:The modified laparoscopic transabdominal cervical cerclage with removable transvaginal tape is a safe,feasible and effective treatment for the patients with cervical incompetence.It not only preserves the advantages of TLTCC,but also shortens the operation time of cerclage and reduces the cesarean section rate caused by cerclage.

引文

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