摘要
目的:探讨孕前经脐单孔腹腔镜极简式宫颈环扎术治疗宫颈机能不全的临床效果、手术安全性和可行性。方法:回顾性分析2022年3月至2022年11月在乌海市妇幼保健院生殖医学科，因宫颈机能不全行孕前经脐单孔腹腔镜极简式宫颈环扎术的3例患者术前、术中、术后的临床资料。结果:3例患者术前资料均满足宫颈机能不全的诊断标准，手术指征明确。3例经脐单孔腹腔镜极简式宫颈环扎术均顺利完成，手术时间分别为68 min、55 min、42 min，术中出血量均<10 ml，术后肛门排气时间分别为15 h、11 h、12 h，术后24 h视觉模拟疼痛评分分别为2分、1分、1分，术后最高体温为36.6～36.8 ℃，无围术期并发症，均于术后第2天顺利出院。术后1周经阴道超声复查环扎带位置均位于宫颈内口水平，且随访期间环扎带没有移位或脱落。术后3个月随访，无切口愈合不良或切口疝发生，且脐部缝合美容效果良好，患者均非常满意。3例患者术后行胚胎移植，现均已临床妊娠，且现孕周均大于前次流产孕周。结论:对宫颈机能不全患者，经脐单孔腹腔镜极简式宫颈环扎术是可行的，但尚需大样本研究支持。
Abstract
Objective:To investigate the clinical effect of pre-pregnancy transumbilical single-port laparoscopic simplified cervical cerclage in the treatment of cervical incompetence, and discuss the safety and feasibility of the operation.Methods:Medical records of 3 patients who underwent transumbilical single-port laparoscopic simplified cervical cerclage between Mar. 2022 and Nov. 2022 at Wuhai Maternal and Child Health Hospital were reviewed. Preoperative, intraoperative, and postoperative clinical data were analyzed.Results:All patients underwent a thorough pre-operative evaluation, showed clear indications for surgery and had a successful transumbilical single-port laparoscopic simplified cervical cerclage. The operation time of 3 patients was 68, 55 and 42 minutes respectively. The amount of bleeding in operation was less than 10 milliliters. Postoperative exhaust time were 15, 11 and 12 hours respectively. The visual analog scale pain score within 24 hours after surgery were 2, 1 and 1 respectively. The postoperative maximum body temperature was 36.6-36.8 ℃. No perioperative complications occurred in 3 patients. All were discharged successfully on the second day after surgery. The position of the cervical suture was located in the isthmus of the uterus according to transvaginal ultrasonography 1 week after the operation, and the cervical suture did not shift or fall off during the follow-up period. No poor wound healing or umbilical hernia occurred at the 3-month follow-up, and the cosmetic effect of umbilical suture was good. Patients were satisfied with the efficacy. Embryo transfer was performed postoperatively in 3 patients, all of whom were clinically pregnant. The current gestational weeks of the three pregnant women are all longer than the gestational weeks of the previous miscarriage.Conclusion:For patients with cervical incompetence, transumbilical single-port laparoscopic simplified cervical cerclage surgery is feasible, but large-sample studies are still needed to verify.
基金项目
内蒙古自治区卫生健康委医疗卫生科技计划项目(202202322)
万方数据