2022 年第 11 期 第 17 卷

宫颈环扎术和阴道孕酮治疗有早产史宫颈功能不全患者的效果和安全性

The efficacy and safety of cervical cerclage and vaginal progesterone on the treatment of uterine cervical incompetence patients with history of premature delivery

作者：邢增丽周玉华薛春颜

英文作者：Xing Zengli Zhou Yuhua Xue Chunyan

单位：海南医学院第一附属医院产科，海口570000

英文单位：Department of Obstetrics the First Affiliated Hospital of Hainan Medical College Haikou 570000 China

关键词：宫颈功能不全；宫颈环扎术；阴道孕酮治疗

英文关键词：Uterinecervicalincompetence;Cervicalcerclage;Vaginalprogesteronetherapy

• 摘要：

• 目的 探讨宫颈环扎术和阴道孕酮治疗有早产史宫颈功能不全患者的效果和安全性。方法 本研究为单中心回顾性研究，选取海南医学院第一附属医院2018年5月至2021年5月收治的有早产史的宫颈功能不全患者170例。根据接受宫颈环扎术时机或阴道孕酮治疗将患者分为紧急宫颈环扎组（57例）、择期宫颈环扎组（56例）和阴道孕酮组（57例）。紧急宫颈环扎组和择期宫颈环扎组患者均接受宫颈环扎术治疗，阴道孕酮组予黄体酮阴道缓释凝胶阴道内给药。主要观察指标为患者妊娠结局，次要观察指标为新生儿结局、接受宫颈环扎术患者围术期并发症及所有患者治疗前后阴道微生态情况。结果 择期宫颈环扎组、紧急宫颈环扎组患者的治疗时间、开始治疗后2周的宫颈管长度、分娩时胎龄均长于/大于阴道孕酮组，剖宫产比例低于阴道孕酮组，择期宫颈环扎组分娩时孕周≥37周比例高于阴道孕酮组和紧急宫颈环扎组，差异均有统计学意义（均P＜0.05）。择期宫颈环扎组、紧急宫颈环扎组围产期新生儿死亡率、Apgar评分＜7分比例、新生儿出生体质量＜2 500 g比例均低于阴道孕酮组［1.8%（1/56）、3.5%（2/57）比10.5%（6/57），5.4%（3/56）、3.5%（2/57）比33.3%（19/57），23.2%（13/56）、22.8%（13/57）比56.1%（32/57）］，差异均有统计学意义（均P＜0.05）。接受宫颈环扎术治疗的113例患者中3例（2.7%）出现围术期并发症（胎膜破裂、宫颈裂伤、术后感染各1例），接受阴道孕酮治疗的57例患者中1例（1.8%）出现阴道出血，2组并发症发生率比较差异无统计学意义（χ2=1.263，P=0.126）。治疗前后，3组阴道微生态Nugent评分比较差异均无统计学意义（均P＞0.05）。结论 对于有早产史的宫颈功能不全患者，宫颈环扎术在母体和新生儿结局中显示出更多的益处，采用择期宫颈环扎手术治疗效果最佳，宫颈环扎术与阴道孕酮干预措施在短期随访时间内都是安全的。

• Objective To explore the efficacy and safety of cervical cerclage and vaginal progesterone on the treatment of uterine cervical incompetence patients with history of premature delivery. Methods This was a single center retrospective study. Totally 170 patients with uterine cervical incompetence who had history of premature delivery admitted to the First Affiliated Hospital of Hainan Medical College were selected from May 2018 to May 2021. According to the different time of receiving cervical cerclage treatment and vaginal progesterone treatment, patients were divided into emergency cervical cerclage group (57 cases), elective cervical cerclage group (56 cases) and vaginal progesterone group (57 cases). The emergency and elective cervical cerclage groups were treated with cervical cerclage, and the vaginal progesterone group was treated with progesterone sustained-release vaginal gel intravaginal administration. The main observation indicator was patients′ pregnancy outcomes, and the secondary observation indicators were neonatal outcomes, perioperative complications in patients who underwent cervical cerclage, and vaginal microecology before and after treatment in all patients. Results The therapeutic duration, cervical length 2 weeks after treatment, and gestational age at delivery in emergency cervical cerclage group and elective cervical cerclage group were longer/larger than those in vaginal progesterone group, the rate of cesarean section was higher than that in vaginal progesterone group, and the rate of gestational week ≥37 weeks at delivery in elective cervical cerclage group was higher than those of vaginal progesterone group and emergency cervical cerclage group (all P<0.05). The perinatal neonatal mortality, and rates of Apgar score ＜7 and nweborn birth weight <2 500 g in emergency cervical cerclage group and elective cervical cerclage group were lower than those in vaginal progesterone group ［1.8%（1/56）, 3.5%（2/57） vs 10.5%（6/57）; 5.4%（3/56）, 3.5%（2/57） vs 33.3%（19/57）; 23.2%（13/56）, 22.8%（13/57） vs 56.1%（32/57）］(all P<0.05). Of which 113 patients underwent cervical cerclage, 3 cases (2.7%) of them had perioperative complications, including 1 case of rupture of membranes, 1 case of cervical laceration, and 1 case of postoperative infection; 1 case (1.8%) who received vaginal progesterone developed vaginal bleeding during treatment, and the difference in the incidence of complications of was no statistically significant betweent the two groups (χ2=1.263， P=0.126). There was no significant difference in vaginal microecology Nugent score among the three groups before and after treatment (all P<0.05). Conclusion For uterine cervical incompetence patients with history of premature delivery, cervical cerclage shows more benefits in maternal and neonatal outcomes. Elective cervical cerclage surgery has the best therapeutic effect, and both cervical cerclage and vaginal progesterone are safe during short-term follow-up.