摘要
目的探讨盆腔子宫内膜异位症(EMs)合并不孕患者行宫腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)治疗后自然妊娠的影响因素。方法选择2008年1月至2018年1月于北京朝阳医院因盆腔EMs合并不孕行宫腹腔镜手术联合术后GnRH-a治疗的患者175例为研究对象,随访12~116个月,分析影响术后自然妊娠的临床因素。结果145例完整随访,随访率82.86%,术后自然妊娠率57.93%(84/145)。术后1~12个月累积自然妊娠率为44.83%,分别与术后13~24个月、25~36个月相比,差异有统计学意义(P<0.0001)。单因素分析显示,年龄>35岁组与≤35岁组相比、子宫内膜异位症生育指数(EFI)评分>4分组与EFI≤4分组相比,术后自然妊娠率差异有统计学意义(P<0.05),而EMs分期(r-AFS)各组间比较,差异无统计学意义(P>0.05)。多因素Cox回归分析显示:不孕时间是影响术后自然妊娠的独立危险因素(OR=0.125,P<0.001);不孕类型、术后输卵管通畅性为影响术后自然妊娠的独立保护因素(OR=4.684、2.196,P<0.001、P<0.05)。结论宫腹腔镜手术联合GnRH-a治疗盆腔EMs合并不孕患者,可提高其术后自然妊娠率,术后1年内是妊娠最佳时机。对于EFI≤4分组,尤其合并高危因素如年龄>35岁、不孕时间>3年、原发不孕及术后仍有输卵管梗阻,建议尽快辅助生殖受孕。
Objective To investigate the factors which influence the postoperative natural pregnancy in patients withpelvic endometriosis(EMs)and infertility after treatment by laparoscopic hysteroscopy combined with gonadotropin-releasing hormone agonist(Gn RH-a).Methods Totally 175 patients with EMs and infertility were enrolled andfollowed-up for 12 to 116 months,who underwent laparoscopic hysteroscopy combined with postoperative Gn RH-atreatment at Beijing Chaoyang Hospital from January 2008 to January 2018.The clinical factors that affectedpostoperative natural pregnancy were analyzed.Results Totally 145 cases were followed up completely,the follow-uprate was 82.86%,and the postoperative natural pregnancy rate was 57.93%(84/145).Compared with the pregnancy at 13 to 24 months and that at 25 to 36 months after operation,natural pregnancy during 1 to 12 months after operation was ofsignificantly difference(P<0.0001).Univariate analysis showed that there was a significant difference in thepostoperative natural pregnancy rate between the group of age>35 years and the group≤35 years,and between thegroups with endometriosis fertility index(EFI)score>4 and those with the score≤4(P<0.05),while the comparisonamong different r-AFS-stage groups showed no statistical difference(P>0.05).Multivariate Cox regression analysisshowed that the time of infertility>3 years was an independent risk factor for postoperative spontaneous pregnancy(OR=0.125,P<0.001);secondary infertility and postoperative patency of both fallopian tubes were independent protectivefactors for postoperative natural pregnancy(OR=4.684,2.196,P<0.001,P<0.05).Conclusion Laparoscopic hysteroscopy combined with GnRH-a in the treatment ofEMs with infertility can increase the natural pregnancyrate after surgery.The best time for pregnancy is within 1 year after operation.For groups with EFI≤4,especially those with high-risk factors such as age>35 years,infertility time>3 years,primary infertility,and postoperativefallopian tube obstruction,it is recommended to have as
作者
李淑红
孙恒子
庄慧宇
张震宇
刘崇东
LI Shu-hong;SUN Heng-zi;ZHUANG Hui-yu;ZHANG Zhen-yu;LIU Chong-dong(Department of Obstetrics and Gynecology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2020年第12期1188-1191,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划(2017YFC1001204)。
