Objective: To discuss the surgical effect of modified cervical cerclage for the treatment of pregnant women with cervical insufficiency. Methods: The clinical data of 225 pregnant women who underwent modified cervical cerclage in Qilu Hospital (Qingdao) were selected for retrospective analysis from April 2014 to June 2020. Surgical success rate, full-term birth rate, preterm birth rate, prolonged pregnancy weeks and newborn birth weight were compared between singleton and twin pregnancies, preventive cerclage and emergency cerclage, surgery before and after 18 weeks, naturally and in vitro fertilization and embryo transfer (IVF-ET) conceived pregnant women respectively. Results: Among the 225 pregnant women, the gestational weeks of surgery were 14-24+5 weeks, mean gestational weeks of delivery were 38+2 weeks (35+5-39+3 weeks), the number of prolonged gestation were (20.3±5.2) weeks, and the newborn birth weight was (3 065±735) g; the overall surgical success rate was 92.9% (209/225), and the miscarriage rate was 7.1% (16/225); among the surviving newborns, the full-term birth rate was 73.7% (154/209), and the preterm birth rate was 26.3% (55/209). All cases had no intraoperative complications. Among the 225 pregnant women, 202 (89.8%, 202/225) cases were singleton pregnancies, and 23 (10.2%, 23/225) cases were twin pregnancies; 201 (89.3%, 201/225) cases underwent preventive cervical cerclage, and 24 (10.7%, 24/225) cases underwent emergency cervical cerclage; 190 (84.4%, 190/225) cases underwent the surgery before 18 weeks, and 35 (15.6%, 35/225) cases underwent the surgery after 18 weeks; 49 (21.8%, 49/225) cases were conceived by IVF-ET. There was no statistically significant difference in the overall surgical success rate of single and twin group (P>0.05). The full-term birth rate, newborn birth weight and prolonged pregnancy weeks of single group were higher than those of twin group (P<0.05). There were no statistical differences between preventive and emergency cerclage in overall surgical success rate, full-term birth rate, preterm birth rate, and newborn birth weight (all P>0.05). The pregnancy prolonged weeks of preventive cerclage was higher than that of emergency cerclage (P<0.05). There were no statistically significant differences in the overall surgical success rate, full-term birth rate, preterm birth rate and birth weight of newborns at different surgical timings (all P>0.05). The pregnancy prolonged week for those who underwent surgery before 18 weeks was higher than that of surgery after 18 weeks (P<0.05). The premature birth rate of IVF-ET was higher than that of naturally conceived pregnant women (P<0.05). Conclusion: The modified cervical cerclage could effectively prolong the gestational weeks of delivery, reduce the rate of preterm birth, and the operation is simple and easy to promote. It could be used as a surgical option for patients with cervical insufficiency.
目的： 探讨改良式子宫颈环扎术用于治疗子宫颈机能不全孕妇的疗效。 方法： 收集2014年4月至2020年6月因子宫颈机能不全于山东大学齐鲁医院（青岛）行改良式子宫颈环扎术的225例孕妇的临床资料进行回顾性分析，分别比较单胎与双胎妊娠、择期环扎术与应急环扎术、不同手术孕周、自然受孕与胚胎移植-体外受精（IVF-ET）者的手术成功率、足月产率、早产率、妊娠延长时间及新生儿出生体重。 结果： 225例孕妇的手术孕周为14周~24周+5，中位分娩孕周为38周+2（35周+5~39周+3），妊娠时间延长（20.3±5.2）周，新生儿出生体重（3 065±735）g；总体手术成功率为92.9%（209/225），流产率为7.1%（16/225）；活产儿足月产率为73.7%（154/209），早产率为26.3%（55/209）；所有孕妇均无术中并发症发生。225例孕妇中，单胎妊娠202例（89.8%，202/225），双胎妊娠23例（10.2%，23/225）；行择期子宫颈环扎术201例（89.3%，201/225），行应急子宫颈环扎术24例（10.7%，24/225）；手术孕周为18周前共190例（84.4%，190/225），18周及以后共35例（15.6%，35/225）；自然受孕者176例（78.2%，176/225），IVF-ET助孕者49例（21.8%，49/225）。单胎、双胎妊娠孕妇的手术成功率比较，差异无统计学意义（P>0.05），单胎妊娠孕妇的足月产率、新生儿出生体重及妊娠延长时间均显著高于双胎妊娠孕妇（P均<0.05）。择期与应急环扎术孕妇的手术成功率、足月产率、早产率及新生儿出生体重分别比较，差异均无统计学意义（P均>0.05），择期环扎术孕妇的妊娠延长时间显著长于应急环扎术者（P<0.05）。不同手术孕周孕妇的手术成功率、足月产率、早产率及新生儿出生体重分别比较，差异均无统计学意义（P均>0.05），18周及以前手术者妊娠延长时间显著长于18周及以后手术者（P<0.05）。IVF-ET受孕者的早产率显著高于自然受孕者（P<0.05）。 结论： 改良式子宫颈环扎术能有效延长分娩孕周，降低早产率，且手术操作简便，易于推广，可作为子宫颈机能不全孕妇的手术选择。.