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目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。
Objective To investigate the effect and safety of laparoscopic cervical cerclage in the treatment of cervical incompetence. Methods From August 2008 to December 2011, 16 cases of vaginal cervical cerclage failed to undergo vaginal cervical cerclage in gynecological department of the First Affiliated Hospital of Sun Yat - sen University from August 2008 to December 2011 were treated with laparoscopic cervical ring Bar surgery, observation of postoperative pregnancy. Results The operation procedure of 16 patients was smooth and none of them was converted to open surgery. There were 10 cases of pregnancy, of which 8 cases of full-term pregnancy cesarean section, 1 case of gestational cesarean delivery for 31 weeks, 1 case of 20 weeks of pregnancy due to premature rupture of membranes lead to inevitable abortion, open surgery to cut the cerclage after Vaginal delivery of the fetus. The average gestational age for cesarean delivery was 37.9 weeks, an average of 17.9 weeks longer than the average preoperative abortion gestational age. Another 6 patients in 5 cases are 1 to 3 months after surgery, not yet planned pregnancy, 1 case after 1 + years, not contraception is not pregnant. Conclusion Laparoscopic cervical cerclage is safe and effective, which can significantly prolong the pregnancy time and increase the live birth rate, which can be used as one of the treatment methods for cervical insufficiency.