宫颈机能不全临床诊疗争议与进展

张 俊伟¹, 李 艳芹¹, 郑 子金¹, 朱 前勇²
1、河南大学人民医院
2、河南省人民医院

摘要

宫颈机能不全指宫颈在足月妊娠前不能维持其正常形态，在没有感染、出血、宫缩等情况下，发生无痛性、进行性漏斗样改变，宫颈外口扩张、羊膜囊膨出，最终导致胎儿丢失。宫颈机能不全是妊娠中期复发性流产和早产的重要原因，发病率逐年增高[2]。有研究显示有妊娠中期流产史的患者，下一次妊娠中期再次流产的风险显著增高[3]。目前宫颈机能不全的病因尚不明确、诊断无统一标准、治疗方法也在不断地探索和改良。

关键词

宫颈机能；临床；诊疗

参考

[1] J-Y Park,Oh K-J,Lee S,et al.A new quantification system for assessing the degree of acute cervical insufficiency based on physical and sonographic examination[J].Eur J Obstet Gynecol Reprod Biol,2021,256372-378. [2] Y Han,Li M,Ma H,et al.Cervical insufficiency:a noteworthy disease with controversies[J].J Perinat Med,2020,48(7):648-655. [3] A-G Edlow,Srinivas S-K,Elovitz M-A.Second-trimester loss and subsequent pregnancy outcomes:What is the real risk?[J].Am J Obstet Gynecol,2007,197(6):581. [4] R Brown,Gagnon R,Delisle M-F.No.373-Cervical Insufficiency and Cervical Cerclage[J].J Obstet Gynaecol Can,2019,41(2):233-247. [5] 陈静,丁文婧,朱晓璐,等.宫颈机能不全的病因学[J].中国实用妇科与产科杂志,2014,30(02):85-88. [6] E-AAnum,Brown H-L,Strauss JF-Rd.Health disparities in risk for cervical insufficiency[J].Hum Reprod,2010,25(11):2894-2900. [7] ACOG Practice Bulletin No.142：Cerclage for the management of cervical insufficiency[J].Obstetrics&Gynecology,2014,123(2):372-379. [8] A-H Shennan,Story L.Cervical Cerclage:Green-top Guideline No.75 Febuary 2022:Green-top Guideline No.75[J].BJOG,2022. [9] 夏恩兰.解读[J].国际妇产科学杂志,2016,43(06):652-656. [10] K-H Nicolaides,Syngelaki A,Poon L-C,et al.A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth[J].N Engl J Med,2016,374(11):1044-1052. [11] S Cruz-Melguizo,San-Frutos L,Martinez-Payo C,et al.Cervical Pessary Compared With Vaginal Progesterone for Preventing Early Preterm Birth:A Randomized Controlled Trial[J].Obstet Gynecol,2018,132(4):907-915. [12] E Mastantuoni,Saccone G,Gragnano E,et al.Cervical pessary in singleton gestations with arrested preterm labor:a randomized clinical trial[J].Am J Obstet Gynecol MFM,2021,3(2):100307. [13] M Goya,de la Calle M,Pratcorona L,et al.Cervical pessary to prevent preterm birth in women with twin gestation and sonographic short cervix:a multicenter randomized controlled trial(PECEP-Twins)[J].Am J Obstet Gynecol,2016,214(2):145-152. [14] A-J Heard,Socrate S,Burke K-A,et al.Silk-based injectable biomaterial as an alternative to cervical cerclage:an in vitro study[J].Reprod Sci,2013,20(8):929-936. [15] Y Zhang,Raia N,Peterson A,et al.Injectable Silk-Based Hydrogel as an Alternative to Cervical Cerclage:A Rabbit Study[J].Tissue EngPart A,2020,26(7-8):379-386. [16] X Huang,Chen R,Li B.Analysis of maternal and neonatal outcomes using cervical cerclage or conservative treatment in singleton gestations with a sonographic short cervix[J].Medicine(Baltimore),2021,100(18):e25767. [17] V Berghella,Ciardulli A,Rust O-A,et al.Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth:systematic review and meta-analysis of randomized controlled trials using individual patient-level data[J].Ultrasound Obstet Gynecol,2017,50(5):569-577. [18] EI-Nashar SA,Paraiso MF,Rodewald K,eral,Laparoscopiccervicosthmic cerclaga[].Gynecol Obstet Inves,2013,75(1):1-8. [19] (美)Steven G.Gabbe 主编,郑勤田,杨慧霞主译.产科学:正常和异常妊娠(第七版)[M].北京:人民卫生出版社,2018:569-585. [20] 王帆.宫颈环扎术治疗宫颈机能不全的诊治进展[J].继续医学教育 2016,30(9):98-101. [21] 夏晓燕,黄醒华,宫颈机能不全的诊治进展[J],实用妇产科杂志,2005,21(4):210-212. [22] 王海玲,杨孜.申叶.等.治疗性子宫颈环扎术临床效果及影响因素分析[J].中国实用妇科与产科杂志,2017,33(9):707-713. [23] 张松英,金晓莹,梁峰冰,等.改良经峡部水平子宫颈环扎术[J]中华妇产科杂志,2014(30):99-101. [24] 卢澄钰,李兆生,王振宇,等检测宫颈机能不全的方法及其循证评价[J].实用妇产科杂志,2018,034(005):347-351. [25] 吴文萃,彭清海.经会阴与经腹部超声检查对宫颈机能不全诊断的临床价值[J].海南医学,2017,28(23):3918-3920. [26] 白蕾,林佳佳经会阴超声检查对宫颈机能不全诊断的临床价值[J].中国基层医药,2012(22):3460-3461.