【摘要】 目的 探讨腹腔镜与经阴道宫颈环扎术治疗双胎妊娠合并宫颈功能不全的疗效。方法 回顾性分析2021年3月～2024年4月我院57例双胎妊娠合并宫颈功能不全行择期手术的临床资料，术前充分告知患者2种手术方式及其利弊，根据患者意愿选择手术方式，经阴道宫颈环扎术26例(阴扎组),腹腔镜宫颈环扎术31例(腹扎组),比较2组手术时间、术中出血量等手术情况，分娩孕周、自发性流产发生率等妊娠结局，新生儿出生体重、Apgar评分等新生儿预后，宫颈裂伤、胎膜早破、绒毛膜羊膜炎等分娩并发症。结果 2组患者术中均未发生严重并发症，阴扎组手术时间[(62.8±19.0)min vs.(79.7±20.4)min,t=-3.212,P=0.002]、术中出血量[15(10,20)ml vs.50(20,50)ml,Z=-3.757,P=0.000]明显短于/少于腹扎组。2组住院时间和术后胎膜早破、产后出血发生率差异无显著性(P>0.05)。阴扎组绒毛膜羊膜炎发生率明显高于腹扎组[19.2%(5/26)vs.0.0%(0/31),P=0.016]。腹扎组延长孕周明显长于阴扎组[(21.9±4.4)孕周vs.(18.6±5.8)孕周，t=-2.377,P=0.021],腹扎组<32孕周分娩率显著低于双胎阴扎组[6.5%(2/31)vs.30.8%(8/26),χ~2=4.222,P=0.040]。腹扎组新生儿出生体重显著高于阴扎组[(2247.4±370.3)g vs.(2037.5±542.0)g,t=-2.289,P=0.025];腹扎组新生儿1分钟Apgar评分[(8.9±1.1)分vs.(7.9±1.8)分，t=-3.130,P=0.002]、5分钟Apgar评分[(9.4±0.7)分vs.(8.9±1.2)分，t=-2.912,P=0.004]显著高于阴扎组；腹扎组5分钟Apgar评分≤7分率[1.7%(1/60)vs.18.8%(9/48),χ~2=7.341,P=0.007],新生儿重症监护室入住率[28.3%(17/60)vs.60.4%(29/48),χ~2=11.226,P=0.000]和高胆红素血症发生率[21.7%(13/60)vs.43.8%(21/48),χ~2=6.029,P=0.014]显著低于阴扎组。结论 预防性经阴道宫颈环扎术和腹腔镜宫颈环扎术均为双胎妊娠合并宫颈功能不全安全有效的治疗方法。腹腔镜宫颈环扎术相较于经阴道宫颈环扎术可降低术后绒毛膜羊膜炎发生率，延长分娩孕周，降低<32孕周自发性早产发生风险，有更好的妊娠结局及新生儿预后。更多还原

【Abstract】 Objective To investigate effects of prophylactic laparoscopic and transvaginal cervical cerclage in the treatment of twin pregnancy complicated with cervical insufficiency. Methods A retrospective analysis was performed on 57 patients with twin pregnancy complicated with cervical insufficiency undergoing elective surgery from March 2021 to April 2024. The patients were fully informed of two surgical methods and their advantages and disadvantages before surgery. According to the patient’s wishes, 26 cases underwent transvaginal cervical cerclage(vaginal cerclage group) and 31 cases underwent laparoscopic cervical cerclage(abdominal cerclage group). The operation time, intraoperative blood loss and other surgery-related conditions, pregnancy outcomes such as gestational age of delivery and incidence of spontaneous miscarriage, neonatal prognosis such as neonatal birth weight and the Apgar score, and complications of childbirth such as cervical laceration, premature rupture of membranes, chorioamnionitis were compared between the two groups. Results No serious complications occurred in both groups. The operation time [(62.8±19.0) min vs.(79.7±20.5) min, t=-3.212, P=0.002] and intraoperative blood loss [15(10, 20) ml vs. 50(20, 50) ml, Z=-3.757, P=0.000] in the vaginal cerclage group were less than those in the abdominal cerclage group. There were no significant differences in hospital stay, incidence of postoperative premature rupture of membranes, and postpartum hemorrhage between the two groups. The incidence of chorioamnionitis in the vaginal cerclage group was significantly higher than that in the abdominal cerclage group [19.2%(5/26) vs. 0.0%(0/31), P=0.016]. The prolong gestational weeks in the abdominal cerclage group were longer than those in the vaginal cerclage group [(21.9±4.4) gestational weeks vs.(18.6±5.8) gestational weeks, t=-2.377, P=0.021]. The delivery rate <32 gestational weeks in the abdominal cerclage group was significantly lower than that in the vaginal cerclage group [6.5%(2/31) vs. 30.8%(8/26), χ~2=4.222, P=0.040]. Compared with the vaginal cerclage group, the abdominal cerclage group had higher birth weight [(2247.4±370.3) g vs.(2037.5±542.0) g, t=-2.289, P=0.025], 1-minute Apgar score [(8.9±1.1) points vs.(7.9±1.8) points, t=-3.130, P=0.002] and 5-minute Apgar score [(9.4±0.7) points vs.(8.9±1.2) points, t=-2.912, P=0.004], and lower incidences of 5-minute Apgar score ≤7 points [1.7%(1/60) vs. 18.8%(9/48), χ~2=7.341, P=0.007], neonatal intensive care unit admission [28.3%(17/60) vs. 60.4%(29/48), χ~2=11.226, P=0.000] and hyperbilirubinemia [21.7%(13/60) vs. 43.8%(21/48), χ~2=6.029, P=0.014]. Conclusions Prophylactic transvaginal cervical cerclage and laparoscopic cervical cerclage are both safe and effective for twin pregnancy complicated with cervical insufficiency. Compared with transvaginal cervical cerclage, laparoscopic cervical cerclage can reduce the incidence of postoperative chorioamnionitis, prolong the gestational week of delivery, reduce the risk of spontaneous preterm birth <32 gestational weeks, and achieve better pregnancy outcomes and neonatal prognosis.更多还原