目的：探讨不同孕期和不同治疗时机行宫颈环扎术治疗宫颈机能不全患者的效果及妊娠结局。方法回顾性分析2010年3月至2014年10月安塞县人民医院收治的119例宫颈机能不全患者的临床资料，其中孕14～16周66例为妊娠早期组，孕17～28周53例为妊娠中期组；又根据入院后待择期行宫颈环扎术治疗78例为非紧急组，入院后行紧急手术治疗41例为紧急组。比较不同孕期、不同治疗时机行宫颈环扎术对妊娠结果的影响。结果妊娠早期组患者手术干预后足月生产率显著高于妊娠中期组[83.3％（55／66）比20.8％（11／53）]，晚期流产率和宫内感染率显著低于妊娠中期组[10.0％（6／66）比68.0％（36／53），7.6％（5／66）比64.2％（34／53）]，差异有统计学意义（P＜0.05）。非紧急组手术干预治疗后足月生产率显著高于紧急组[71.8％（56／78）比24.4％（10／41）]，晚期流产率和宫内感染率显著低于紧急组[20.5％（16／78）比63.4％（26／41），18.0％（14／78）比（61.0％（25／41）]，差异有统计学意义（P ＜0.05）。妊娠早期组住院时间短于妊娠晚期组[（7.3±1.4） d 比（11.2±3.5） d]，差异有统计学意义（P＜0.05）。结论宫颈机能不全患者，应于妊娠14～16周择期行宫颈环扎术治疗；对于孕前宫颈机能不全诊断不明患者，伴早产史或晚期流产史的高危孕妇，在孕中期通过B型超声发现宫颈机能不全，应行紧急宫颈环扎治疗术，术后加强监测，预防感染，从而降低宫内感染率及晚期流产率；提高胎儿足月生产机会，最终达到改善妊娠结局的目的。%Objective To analyze the cervical cerclage treatment of cervical insufficiency during differ-ent pregnancy periods and the impact on pregnant outcomes.Methods One hundred and nineteen patients who had received cervical cerclage for cervical incompetence in Ansai People′s Hospital from Mar.2010 to Oct.2014 were included in the study for a retrospective analysis on the operation timing and pregnancy out-come.There were 66 cases of 14-16 weeks of pregnancy as early pregnancy group,53 cases of 17-28 weeks of pregnancy as mid-term pregnancy group;78 cases receiving elective cervical cerclage after admission to hospi-tal as non-emergency group;41 cases receiving emergent cervical cerclage as emergency group.The effects of different pregnancy periods and different treatment timing of cervical cerclage on pregnancy outcome were compared.Results In the early pregnancy group,the full term delivery rate was significantly higher than the mid-term pregnancy group[83.3%(55/66) vs 20.8%(11/53)],the rate of late abortion and intrauterine infection were significantly lower than of the mid-term pregnancy group[10.0%(6/66) vs 68.0%(36/53), 7.6%(5/66) vs 64.2%(34/53)],the differences were statistically significant(P <0.05).The full term delivery rate of non-emergency group was significantly higher than the emergency group[71.8%(56/78) vs 24.4%(10/41)],and the rate of late abortion and intrauterine infection were significantly lower than the emergency group[20.5%(16/78) vs 63.4%(26/41),18.0%(14/78) vs (61.0%(25/41)],the differ-ences were statistically significant(P<0.05).The length of hospital stay of the early pregnancy group was less than the late pregnancy group[(7.3 ±1.4) d vs (11.2 ±3.5) d],the difference was statistically sig-nificant(P<0.05).Conclusion The cervical cerclage should be given during 14-16 gestational weeks for patients with cervical incompetence;for patients with unclear diagnosis of cervical incompetence emergent cervical cerclage should be given once discovered by B-ultrasound during mid-term pregnancy and postopera-tive monitoring should be done to prevent infection and reduce the late abortion rate and intrauterine infection rate,thus to improve the chance of full term delivery and achieve better pregnancy outcomes .
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