标题：预防性择期宫颈环扎术与期待疗法治疗宫颈机能不全的疗效及安全性分析

      作者：周杨，曾瑞珍，郭彩霞    广州医科大学附属第四医院妇产科，广东 广州 511300

      卷次： 2023年34卷2期

      【摘要】 目的 比较预防性择期宫颈环扎术与期待疗法治疗宫颈机能不全(CIC)的疗效及安全性。方法 回顾性分析2018年6月至2021年5月广州医科大学附属第四医院妇产科收治的90例CIC患者的临床资料，根据手术治疗方法不同分组，其中45例给予期待疗法治疗者纳入对照组，45例给予预防性择期宫颈环扎术治疗者纳入观察组。比较两组患者的妊娠情况、新生儿体质量、妊娠结局，以及治疗前、治疗后1个月的生活质量[采用生活质量量表(SF-36)评价]，同时比较两组患者治疗期间的不良反应发生情况。结果 观察组患者的妊娠延长时间、分娩孕周、妊娠32周宫颈长度及新生儿体质量明显长(高)于对照组，差异均有统计学意义(P<0.05)；观察组患者的足月产率和新生儿存活率分别为86.67%、95.56%，明显高于对照组的 40.00%、75.56%，而早产率和流产率分别为8.89%、4.44%，明显低于对照组的35.56%、24.44%，差异均有统计学意义(P<0.05)；治疗后，两组患者的生理职能、躯体功能、物质生活、社会功能评分均升高，且观察组分别为(73.41±5.11)分、(74.41±5.11)分、(75.41±4.31)分、(74.19±4.99)分，明显高于对照组的(67.41±3.98)分、(68.41±4.98)分、(67.41±5.18)分、(67.41±4.09)分，差异均有统计学意义(P<0.05)；观察组患者的不良反应总发生率为 6.67%，明显低于对照组的 22.22%，差异有统计学意义(P<0.05)。结论 预防性择期宫颈环扎术可有效改善CIC患者妊娠结局，提高足月产率、新生儿存活率及患者生活质量，降低流产率、早产率、不良反应发生率，值得临床推广应用。
      【关键词】 宫颈机能不全；宫颈环扎术；期待疗法；妊娠结局；新生儿体质量；生活质量；不良反应
      【中图分类号】 R711.74 【文献标识码】 A 【文章编号】 1003—6350（2023）02—0214—04

Efficacy and safety of preventive cerclage and expectant therapy in the treatment of cervical incompetence.
ZHOUYang, ZENG Rui-zhen, GUO Cai-xia. Department of Obstetrics and Gynecology, the Fourth Affiliated Hospital ofGuangzhou Medical University, Guangzhou 511300, Guangdong, CHINA
【Abstract】 Objective To compare the efficacy and safety of preventive cerclage and expectant therapy in thetreatment of cervical incompetence (CIC). Methods Ninety CIC patients admitted to the Fourth Affiliated Hospital ofGuangzhou Medical University from June 2018 to May 2021 were selected. According to different surgical treatmentmethods, 45 patients receiving expectant treatment were included in the control group, and 45 patients receiving preven-tive cervical cerclage were included in the observation group. The pregnancy, body mass of newborns, pregnancy out-come, and quality of life of the patients (evaluated with SF-36 Scale) before and after treatment were compared betweenthe two groups, and the adverse reactions during treatment was also compared. Results The prolonged pregnancy, ges-tational weeks of delivery, the length of cervix at 32 weeks of pregnancy, and the body mass of newborns in the observa-tion group were significantly longer (higher) than those in the control group (P<0.05). The term birth rate and neonatalsurvival rate of the patients in the observation group were 86.67% and 95.56%, respectively, which were significantlyhigher than 40.00% and 75.56% in the control group, and the premature delivery rate and abortion rate were 8.89% and4.44%, respectively, which were significantly lower than 35.56% and 24.44% in the control group, respectively, with sta-tistically significant differences (P<0.05). After treatment, the scores of physiological function, physical function, materi-al life, and social function of the patients in the two groups increased, and the scores of the observation group were(73.41±5.11) points, (74.41±5.11) points, (75.41±4.31) points, and (74.19±4.99) points, respectively, which were signifi-cantly higher than (67.41±3.98) points, (68.41±4.98) points, (67.41±5.18) points, and (67.41±4.09) points of the controlgroup (P<0.05). The total incidence of adverse reactions in the observation group was 6.67%, which was significantlylower than 22.22% in the control group (P<0.05). Conclusion Preventive cervical cerclage can effectively improve thepregnancy outcome of CIC patients, improve the term birth rate, neonatal survival rate, and patients' quality of life, re-duce the abortion rate, premature delivery rate, and adverse reaction rate, which is worthy of clinical promotion.
      【Key words】 Cervical insufficiency; Cervical cerclage; Expectant therapy; Pregnancy outcome; Neonatal bodymass; Quality of life; Adverse reaction