宫颈环扎手术的做法?宫颈环扎手术可以选择经阴道、经腹或经腹腔镜手术。The practice of cervix entrapment operation? Cervical entrapment surgery can be selected via vaginal, abdominal or laparoscopic surgery.

　　经阴道手术方法种类较多，如Shirodkar法，McDonald缝扎法、Cautifaris法等，以McDonald缝合法常用。采用McDonald宫颈环扎术或其改良法是简单、安全、有效的治疗方法。There are many types of vaginal surgery methods, such as the Shirodkar method, the McDonald stitch method, the Cautifaris method, etc., which are commonly used by the McDonald stitch. The use of McDonald's cervical-cervix or its modification is a simple, safe and effective treatment.

　　1.暴露宫颈。1. Expose the cervix.

　　2.用宫颈钳夹持宫颈向下做牵引，用7号或10号双股丝线或尼龙线，于膀胱附着稍下处，由11点进针，穿入宫颈黏膜肌层，再于10点穿出。2. Use the cervix clamp to hold the cervix down for traction. Use the No. 7 or No. 10 double wire or nylon wire to attach slightly lower to the bladder. From 11 o'clock, insert the needle into the cervix mucosal muscle layer and wear it out at 10 o'clock.

　　3.用宫颈钳将宫颈向上牵拉，针线继续于宫颈7～8点、4～5点、1～2点处做袋状缝合。3. Use cervical pliers to pull the cervix upwards, and the stitches continue to be bagged at 7-8 points, 4-5 points, and 1-2 points of the cervix.

　　4.拉紧缝线，于前穹隆打结，结扎紧固程度以容指尖为度。4. Tighten the sutures and tie them in the front vault. The degree of ligation is to the fingertip.

　　对有宫颈机能不全病史，但因宫颈损伤不能接受经阴道宫颈环扎术的妇女可选择接受经腹或经腹腔镜宫颈内口环扎术。随着腹腔镜技术的飞速发展，1998年出现了腹腔镜宫颈环扎的方法。微创技术与环扎的结合为宫颈机能不全的患者带来了更大的益处，大大减少了需要进行经腹手术患者的痛苦。但是需要强调的是如果孕中晚期万一需要经阴道分娩，就必须经腹腔镜或者开腹拆除缝线，否则一旦产程启动是很危险的，需要紧急手术拆除缝线。For women with a history of cervical insufficiency, women who can not accept vaginal cervix because of cervical injury can choose to undergo transperitoneal or transperitoneal cervix. With the rapid development of laparoscopic technology, laparoscopic cervix ring method appeared in 1998. The combination of minimally invasive technology and ring-zonation has brought greater benefits to patients with cervical insufficiency and greatly reduced the pain of patients who need to undergo abdominal surgery. However, it should be emphasized that if the middle and late stages of pregnancy require vaginal delivery, they must be removed by laparoscope or open abdomen. Otherwise, once the birth process is started, it is very dangerous and emergency surgery is required to remove the stitches.

　　非孕期行腹腔镜下子宫峡部环扎术选择月经干净后3-7天施术。患者取膀胱截石位，取脐部及下腹两侧共3个穿刺点，置入腹腔镜及操作器械进行手术操作。经阴道放置举宫器上推子宫，在镜下用单极电凝切开膀胱腹膜返折，推开膀胱，暴露子宫峡部及两侧的子宫血管。然后用两端带针的聚丙烯环扎带(Mersilene带)行宫颈环扎。将缝针由弯变直，在子宫峡部与子宫血管之间的无血管区由前向后进针，出针点仍选择在子宫峡部与子宫血管之间。在进行宫腔镜检查排除环扎带位于宫颈管后，将Mersilene带拉紧，环扎子宫峡部，将结打在子宫峡部后方。腹膜反折可不必缝合。最好在峡部放置两条环扎带，以加强子宫峡部的支撑力。

　　Laparoscopic hysterectomy during pregnancy was performed 3-7 days after menstrual cleansing. The patient took a bladder truncated stone, took a total of 3 puncture points on the umbilical cord and both sides of the lower abdomen, and placed a laparoscope and operating equipment for surgical operation. After the vagina is placed on the lift, push the uterus, and under the mirror, the bladder peritoneum is cut with a unipolar electrocoagulation, the bladder is pushed, and the uterine blood vessels on the isthmus and on both sides are exposed. The cervix ring is then tied with a polypropylene band(Mersilene band) with needles at both ends. The stitches are straightened from the bend, and the anastomotic area between the Isthmus of the uterus and the uterine blood vessels is moved from the front to the back, and the point of the needle is still selected between the isthmus and the uterine blood vessels. After the hysteroscopic examination of the exclusion ring band is located in the cervix, the Mersilene belt is pulled tight and the ring is tied to the hysterectomy, which will be tied behind the hysterectomy. The peritoneum is folded back without stitching. It is best to place two rings in the isthmus to strengthen the support of the isthmus.

　　如果是在孕期进行子宫峡部环扎，则不需要在宫腔内放置举宫器。具体操作方法如下：手术采用四穿刺孔进行。用超声刀将圆韧带剪断，助手钳夹圆韧带近子宫断端，将子宫牵拉向一侧，暴露术侧阔韧带，剪开阔韧带无血管区至膀胱腹膜反折水平，用宫颈钳钳夹推起宫颈，超声刀剪开膀胱腹膜反折，推开膀胱，暴露子宫峡部宫旁血管束，以mersilene环扎带的弯针分别由子宫血管束的内侧、由后向前进针，将线结打在子宫峡部前方。打结后不剪断环扎带，将环扎带的穿刺针自血管内侧由前向后穿刺，绕过宫颈后方，再自子宫峡部另一侧血管内侧由后行前穿刺，到达子宫峡部前方，再次环扎子宫峡部，完成子宫峡部双重环扎。

　　If the hysterectomy is performed during pregnancy, there is no need to place a lift in the uterine cavity. The specific operation method is as follows: The operation is carried out with four piercings. The round ligament was cut with a ultrasonic knife. The assistant clamp clamped the ligament near the hysterectomy, pulled the uterus to one side, exposed the lateral broad ligament, cut the open ligament without blood vessels to the bladder peritoneum reflexed level, and used the cervical clamp. The clamp CLIP pushes the cervix, The ultrasound knife cuts open the bladder peritoneum and folds back, pushes the bladder away, exposes the blood vessel bundle next to the uterine isthmus, and the curved needles with the mersilene ring are wound from the inside of the uterine vascular bundle, and then forward into the needle, and the line is tied in front of the uterine isthmus. After the knot, do not cut the loop, puncture the puncture needle from the inside of the blood vessel from the front to the back of the cervix, bypass the back of the cervix, and then from the inside of the blood vessel on the other side of the hysterectomy, reach the front of the hysterectomy, and once again encircle the hysterectomy. Complete the double loop of the hysterectomy.