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目的:通过对习惯性流产和早产患者行改良式倒U字双重缝扎宫颈术进行临床分析,探讨宫颈内口双重缝扎错位打结治疗孕中晚期宫颈机能不全的疗效,分析影响手术成功率的相关因素,预防因宫颈机能不全造成的晚期流产及早产。方法:对62例宫颈机能不全的患者于妊娠14～24周进行宫颈环扎等治疗。A组30例采取Mcdonald手术方法,在宫颈与于阴道的交界处环绕宫颈縫3针打结,同期进行保胎治疗;B组32例(包括A组流产、早产后第2次治疗的8例)采取改良式倒U字双重缝扎,采取Mcdonald手术方法,形成倒U字打结后进行牵拉,在不切开阴道黏膜的同时,使第2道缝扎线在第1道缝线之上0.5 cm近子宫颈内口处共3针,双重缝扎线错位结扎,线结位于后穹窿,避免膀胱刺激症状出现,尽可能地延长孕周。结果:A组30例采取Mcdonald手术方法有8例流产或早产,胎儿未存活,成功率73.33%。B组32例采取改良式倒U字双重缝扎,有1例霉菌性阴道炎早期流产,1例胎儿肠外置胎死宫内引产,成功率93.75%,两组差异有统计学意义(P<0.01)。结论:改良式倒U字双重缝扎治疗宫颈机能不全引起的反复晚期流产在Mcdonald手术方法的基础上,在不切开阴道黏膜的同时,使第2道缝扎线位于近子宫颈内口处,双重缝扎线结位置在后穹窿,避免膀胱刺激症状出现,尽可能地延长孕周。该方法简单、省时、损伤小,成功率高,患者依从性好,值得推广。
OBJECTIVE: To analyze the clinical effect of modified inverted U-shaped double-suture cervical surgery on patients with habitual abortion and premature labor to explore the effect of double suture dislocation and cervical knot in the treatment of cervical incompetence in the second trimester of pregnancy. Related factors to prevent due to cervical insufficiency caused by late abortion and premature delivery. Methods: 62 cases of cervical incompetence in patients with cervical cerclage 14 to 24 weeks of pregnancy and other treatment. A group of 30 patients to Mcdonald surgery method, at the junction of the cervix and the vagina around the cervical seam 3 knot knot, the same period of miscarriage; B group of 32 patients (including A group of miscarriage, premature delivery of the second treatment of 8 cases ) To take an inverted double U-shaped suture to take Mcdonald surgery method to form an inverted U-shaped knot after the pull, do not incision in the vaginal mucosa at the same time, so that the first 2 sutures in the first suture line suture 0.5 cm near the mouth of the cervix a total of 3-pin, double suture dislocation ligation, knot in the posterior fornix to avoid bladder irritation, prolonged gestational age as possible. Results: A group of 30 cases to Mcdonald surgery method 8 cases of abortion or premature birth, the fetus did not survive, the success rate of 73.33%. In group B, 32 patients were treated with modified inverted U-shaped double suture, 1 case of early vaginal discharge of fungal vaginitis, and 1 case of fetus induced by fetal external enucleation, the success rate was 93.75%, with significant difference between the two groups (P < 0.01). Conclusions: The modified inverted U-shaped double suture treatment of cervical incompetence caused by repeated late abortion Mcdonald surgery based on the method, without incising the vaginal mucosa at the same time, the second suture line located near the mouth of the cervix , Double suture knot position in the posterior fornix to avoid the symptoms of bladder irritation, as long as possible to extend gestational age. The method is simple, time-saving, less damage, high success rate, patient compliance is good, it is worth promoting.