摘要
目的探讨子宫内膜异位症合并不孕患者宫-腹腔镜术后妊娠率并分析其影响因素,验证子宫内膜异位症生育指数评分(EFI)对术后妊娠的预测价值,以期提高术后妊娠率。方法纳入2014年1月1日—2017年7月31日在广州市妇女儿童医疗中心行宫-腹腔镜的子宫内膜异位症合并不孕患者,收集每位研究对象的临床信息和3年随访资料后,计算各时间点的累积妊娠率,根据术后是否妊娠分成两组,应用单因素和多因素logistic分析探究术后妊娠的影响因素。再根据不同EFI评分分成EFI≤4分、4分<EFI≤6分、6分<EFI≤8分及EFI≥9分共4组,验证EFI评分与术后妊娠的关系。结果本研究共纳入354例患者(非妊娠组135例,妊娠组219例),术后3年累积妊娠率约为61.9%,随时间延长,累积妊娠率增长明显减缓。多因素logistic分析表明,继发性不孕、不孕年限<3年、高抗缪勒管激素(AMH)水平、高EFI评分及术后接受ART治疗是术后妊娠的有利因素(均P<0.05)。EFI≥9组患者术后3年累积妊娠率是EFI≤4组的2倍。EFI评分越高,各时间点的累积妊娠率均越高(χ^(2)=12.256、18.078、15.653、15.157,均P<0.05)。EFI评分较低的患者更倾向于术后接受辅助生殖技术(ART)治疗(χ^(2)=12.648,P<0.05)。结论子宫内膜异位症并不孕患者宫-腹腔镜术后可获得良好的妊娠率,继发性不孕、不孕年限<3年、高AMH水平、高EFI评分及术后接受ART治疗是术后妊娠的有利因素,应用EFI评分能有效进行术后生育潜力预测和生育指导。
Objective The objective is to estimate the postoperative pregnancy rate after hysteroscopic-laparoscopic surgery in patients with endometriosis-associated infertility and explore its risk factors to improve the pregnancy rate.Methods Patients with endometriosis-associated infertility who underwent hysteroscopic-laparoscopic surgery from January 1,2014 to July 31,2017,in the GYN Department of Guangzhou Women's and Children's Medical Center were included in our study.The cumulative pregnancy rates at different points in time were calculated after collecting clinical data and a 3-year follow-up of the study population.Patients were divided into two groups according to whether they were pregnant.We studied the risk factors of pregnancy after hysteroscopic-laparoscopic surgery in patients with endometriosis-associated infertility by univariate analysis and multifactorial logistic regression analysis.The results were shown as an OR value with a 95%confidence interval and a p-value.Patients were then divided into four groups(EFI≤4,4<EFI≤6,6<EFI≤8,and EFI≥9)according to EFI scores to explore the relationship between EFI scores and pregnancy in endometriosis-associated infertility.Results A total of 354 patients(135 cases in the non-pregnant group and 219 in the pregnant group)were included in the study.The cumulative pregnancy rate three years after hysteroscopic-laparoscopic surgery in patients with endometriosis-associated infertility was 61.9%.The growth of the cumulative pregnancy rate slowed significantly over time.Multifactorial logistic analysis showed that secondary infertility,infertility time<3 years,high AMH levels,high EFI scores,and postoperative ART treatment were beneficial factors in postoperative pregnancy(all P<0.05).The EFI≥9 group's cumulative pregnancy rate was almost twice that of the EFI≤4 group three years after surgery.The higher the EFI score,the higher the cumulative pregnancy rate at all points in time(all P<0.05).Patients with a lower EFI score were more likely to receive postoper
作者
卢燕玲
谢静颖
杨艳
廖耘生
范佳颖
LU Yan-ling;XIE Jing-ying;YANG Yan;LIAO Yun-sheng;FAN Jia-ying(Department of Gynaecology and Obstetrics,Guangzhou Women and Children's Medical Center,Guangzhou,Guangdong 510000,China)
出处
《中国妇幼保健》
CAS
2023年第5期847-851,共5页
Maternal and Child Health Care of China
基金
广东省医学科学技术研究基金项目(A2016027)。
