探讨对宫颈功能不全(CI)非孕期育龄女性采取腹腔镜下宫颈环扎术(LAC)，以及对CI中孕期(12~16孕周)孕妇采取经阴道宫颈环扎术(TVC)治疗的临床疗效及其妊娠结局。

选择2016年8月至2020年6月，于成都市妇女儿童中心医院被诊断为CI，并拟进行宫颈环扎术(CC)治疗的171例患者为研究对象。按照CC治疗时CI患者妊娠与否，将其分为研究组(n＝118，接受LAC的非孕期育龄女性)与对照组(n＝53，接受TVC的中孕期孕妇)。采取前瞻性队列研究方法，对2组CI患者的临床资料、CC治疗成功率(≥28孕周分娩)、≥34孕周分娩率、流产率、新生儿出生体重及手术相关指标进行统计学分析(成组t检验及χ²检验)。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求，并与所有受试者签署临床研究知情同意书。2组CI患者年龄、孕次、流产次数、流产时孕龄、宫颈内口直径及宫颈管长度等临床资料比较，差异均无统计学意义(P>0.05)。

①研究组CI患者TVC手术持续时间、术中出血量，均显著长于及多于对照组，并且差异均有统计学意义(t＝9.742、Z＝-9.463，P均<0.001)。2组患者住院时间比较，差异无统计学意义(P>0.05)。2组患者均无术中、术后相关并发症发生，并且术后均顺利出院。②2组CI患者接受CC治疗后的CC治疗总体成功率为90.6%(155/171)。研究组CI患者的CC治疗成功率、足月分娩(≥37孕周分娩)率、≥34孕周分娩率、流产率、分娩孕龄及新生儿出生体重，均优于对照组，并且差异均有统计学意义(χ²＝8.192、10.858、9.319、8.192，t＝3.452、4.823，P均<0.05)。2组CI患者早产(>28~37孕周分娩)率比较，差异无统计学意义(P>0.05)。

CI非孕期育龄女性接受LAC后，相较于CI中孕期孕妇接受TVC的临床疗效更好。但是，CI中孕期孕妇TVC手术持续时间及术中出血量更短、更少，而且患者可经阴道分娩，由此可避免剖宫产术分娩的相关风险。对CI患者采取LAC与TVC各有利弊，临床应根据患者个体差异进行治疗方案选择。

To investigate clinical efficacy and pregnancy outcomes between patients with cervical incompetence (CI) of non-pregnant women of childbearing age underwent laparoscopic abdominal cervical cerclage (LAC), and of pregnant women in the second trimester (12-16 gestational weeks) underwent transvaginal cervical cerclage (TVC).

A total of 171 patients with CI who planned to undergo cervical cerclage (CC) from August 2016 to June 2020 in Chengdu Women′s and Children′s Central Hospital were selected as research subjects. According to whether CI patients were pregnant or not during CC treatment, they were divided into research group (n=118, non-pregnant women of childbearing age who received LAC) and control group (n=53, pregnant women who received TVC in the second-trimester). Clinical data, including successful rate of CC treatment (≥28 gestational weeks deliver), rate of ≥34 gestational weeks deliver, miscarriage rate, neonatal birth weight and surgery-related indicators between two groups were analyzed by prospective cohort study method and compared by independent-samples t test and chi-square test. The procedures followed in this study were in line with the requirements of newly revised World Medical Association Helsinki Declaration in 2013, and informed consent for clinical study was signed with all subjects enrolled in this study. There were no significant differences among clinical data of age, gravidity, times of abortion, gestational weeks at abortion, diameter of cervical internal os and length of cervix between two groups (P>0.05).

①Average operation duration and volume of intraoperative blood loss of TVC in CI patients of research group were significantly longer or more than those in control group, and differences were statistically significant (t=9.742, Z=-9.463; both P<0.001). There was no statistical difference in hospitalization time between two groups (P>0.05). There were no complications during operation and postoperation between two groups, and all patients were discharged after operation. ②The overall successful rate of CC treatment between two groups after CC treatment was 90.6% (155/171). The successful rate of CC treatment, rates of term delivery (≥37 gestational weeks deliver), ≥34 gestational weeks deliver, and miscarriage, gestational age at deliver and neonatal birth weight in research group were all better than those in control group, and all differences were statistically significant (χ²=8.192, 10.858, 9.319, 8.192; t=3.452, 4.823; all P<0.05). There was no significant difference in rate of preterm birth (>28-37 gestational weeks deliver) between two groups (P>0.05).

Clinical curative effect of LAC that non-pregnant women with CI of childbearing age underwent is much better than that of TVC in pregnant women with CI in the second trimester. However, average operation duration and volume of intraoperative blood loss of TVC in pregnant women with CI in the second trimester were shorter and less, and vaginal delivery was available. LAC and TVC for treatment of CI patients have their own advantages, it is important to target CI patients to choice individual treatment schemes.