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目的探讨环扎位点距离和子宫峡部生物物理参数的相关性。方法 40例孕前宫颈机能不全行宫颈环扎手术患者,根据环扎位点距离分为A组(距膀胱返折腹膜下5 mm,宫旁1 cm)和B组(环扎位点平膀胱返折腹膜,宫旁1 cm),每组20例,两组患者术后均接受子宫CT探查子宫峡部生物物理参数,并与应用数显卡尺测量20例因病切除的全子宫或广泛全子宫新鲜离体标本的子宫峡部生物物理参数作对比,采用非条件Logistic回归分析模型分析环扎位点距膀胱返折腹膜下5 mm,宫旁1 cm的影响因素。结果三组各项子宫峡部生物物理参数比较差异均具有统计学意义(P<0.05);B组患者各项子宫峡部生物物理参数显著低于A组和新鲜离体子宫标本,差异均具有统计学意义(P<0.05或0.01);A组和新鲜离体子宫标本各项子宫峡部生物物理参数比较差异无统计学意义(P>0.05)。Logistic回归分析显示,峡部宽度、峡部长度、膀胱反折腹膜剥离起始部距离、峡部外缘距子宫血管内缘距离、子宫动脉内径、子宫动脉外径、宫颈内口至外口距离、峡部宫颈宽(外径)、子宫前壁厚度、子宫后壁厚度、峡部宫颈周径均是子宫峡部环扎位点距离的独立影响因素(OR=3.692、3.941、3.916、3.826、3.685、4.545、9.098、4.387、4.336、4.328、4.318,P<0.05)。结论子宫峡部环扎位点距膀胱返折腹膜下5 mm,宫旁1 cm可保证宫颈机能不全患者获取更优的手术效果。
Objective To investigate the relationship between the site of cerclage and the biophysical parameters of isthmus. Methods Forty patients undergoing cervical cerclage with cervical incompetence before pregnancy were divided into group A (5 mm below the peritoneum, 1 cm from the uterus) and group B Fold the peritoneum, 1 cm in the pavilion), 20 cases in each group. The biomechanical parameters of uterine isthmus were examined by uterine CT in both groups after operation, and 20 cases with whole uterus or extensive uterus The non-conditional Logistic regression model was used to analyze the influencing factors of the cerclage location 5 mm below the peritoneum and 1 cm from the uterus beside the cicatrix. Results The biomechanical parameters of isthmus in each group were statistically different (P <0.05). The biophysical parameters of isthmus in each group were significantly lower than those in group A and fresh uterus specimens, the differences were statistically significant (P <0.05 or 0.01). There was no significant difference in biophysical parameters of isthmus in group A and fresh uterus (P> 0.05). Logistic regression analysis showed that the width of isthmus, isthmus length, distance from the origin of peritoneal debridement, the distance from isthmus to uterine artery, the diameter of uterine artery, the diameter of uterine artery, the distance from cervix to mouth, The width (OD), anterior uterine wall thickness, posterior uterine wall thickness and isthmic cervical circumference were the independent influencing factors for the distance of the isthmus (OR = 3.692,3.941,3.916,3.826,3.685,4.545,9.098, 4.387, 4.336, 4.328, 4.318, P <0.05). Conclusions The isthmus of uterus isthmus is 5 mm below the peritoneum and 1 cm from the uterus of the bladder to ensure that the patients with cervical incompetence obtain better surgical results.