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目的探讨子宫内膜异位症(endometriosis,EM)合并不孕患者治疗后妊娠情况。方法总结184例EM合并不孕患者治疗后妊娠情况。按照1985年美国生育协会修订的内异症分期标准进行分期,其中Ⅰ期64例,Ⅱ期20例,Ⅲ期54例,Ⅳ期46例;并于腹腔镜下进行卵巢异位内膜病灶切除和粘连分解、盆腔腹膜异位内膜病灶电凝及输卵管整形通液术。按照术后1～12个月、13～24个月、25～36个月进行分组,分析期待妊娠的妊娠率与时间的关系。选用年龄、不孕类型、EM分期进行多因素logistic回归,分析其妊娠相关的影响因素。结果研究对象中总的妊娠率44.6%,其中术后第1、2、3年妊娠率分别为34.8%、11.7%、3.8%。术后第1年与术后第2年妊娠率比较及术后第2年与术后第3年妊娠率比较,均有显著性差异(P<0.01)。以年龄、不孕类型、EM分期为分变量行logistic回归分析P值分别为0.283、0.986、0.018。EM分期与术后第1年妊娠情况有相关性。Ⅲ～Ⅳ患者单纯手术与术后加用辅助治疗妊娠率比较无显著性差异(P>0.05)。结论腹腔镜手术可提高EM患者的妊娠率,以1年内妊娠率最高。内异症分期是术后妊娠率的唯一影响因素。术后加用辅助治疗不提高期待妊娠率。
Objective To investigate the pregnancy status of patients with endometriosis (EM) complicated with infertility. Methods A total of 184 cases of EM with infertility patients after treatment of pregnancy. According to the United States Fertility Association in 1985 revised endometrial staging staging criteria, including 64 cases of stage Ⅰ, stage Ⅱ 20 cases, stage Ⅲ 54 cases, stage Ⅳ 46 cases; and laparoscopic resection of ovarian ectopic endometrium And adhesions decomposition, pelvic peritoneal ectopic endometrial lesions electrocoagulation and tubal plastic surgery. According to 1 to 12 months after surgery, 13 to 24 months, 25 to 36 months were grouped to analyze the relationship between expectant pregnancy rate and time. Age, type of infertility and EM staging were used for multivariate logistic regression analysis to analyze the factors related to pregnancy. Results The total pregnancy rate in study subjects was 44.6%. The pregnancy rates at the first, second and third years after surgery were 34.8%, 11.7% and 3.8% respectively. There was a significant difference (P <0.01) between the first year after operation and the second year after operation, and between the second year after operation and the third year after operation. Logistic regression analysis showed that P values were 0.283, 0.986, and 0.018 respectively, according to age, type of infertility and EM staging. EM staging and postoperative 1 year pregnancy have a correlation. Ⅲ ~ Ⅳ patients with surgery alone and postoperative plus adjuvant treatment of pregnancy rate was no significant difference (P> 0.05). Conclusion Laparoscopic surgery can improve the pregnancy rate of patients with EM, the highest pregnancy rate within 1 year. Endometriosis staging is the only influencing factor of postoperative pregnancy rate. Postoperative plus adjuvant therapy does not increase the expected pregnancy rate.