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目的 观察应用腹腔镜诊断和治疗盆腔子宫内膜异位症 (内异症 )及不孕症的疗效。方法 对 314例经腹腔镜诊断为盆腔内异症的患者 ,按 1985年美国生育学会修订的内异症分期标准(r AFS)进行分期 ,其中Ⅰ期 5 8例 ,Ⅱ期 173例 ,Ⅲ期 6 8例 ,Ⅳ期 15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内凝固术及清除腹腔液等手术治疗。术后随访 36周 ,对妊娠者随访到妊娠 2 0周。比较不同r AFS分期患者术后累计妊娠率和流产率。结果 314例患者术后 36周内妊娠共 2 5 4例 ,分别为Ⅰ期 5 0例 (86 2 % ,5 0 / 5 8) ,Ⅱ期 14 1例 (81 5 % ,14 1/ 173) ,Ⅲ期 5 2例 (76 5 % ,5 2 / 6 8)和Ⅳ期 11例 (73 3% ,11/ 15 )。经统计学检验 ,各期患者累计妊娠率比较 ,差异无统计学意义 (P >0 0 5 ) ;术后 2 4周内的妊娠率 (93 7% ,2 38/ 2 5 4 )高于术后 2 5～ 36周 (6 3% ,16 / 2 5 4 ;P <0 0 1)。 2 5 4例妊娠患者中 ,流产 12例 ,流产率与分期无关 (P >0 0 5 ) ;妊娠 12周内流产率 (83 3% ,10 / 12 )高于妊娠 12周后 (16 7% ,2 / 12 ;P <0 0 5 )。结论 应用腹腔镜可检查、诊断各期内异症及其引起不孕症的盆腔因素 ;腹腔镜手术治疗可提高内异症患者的妊娠率。在腹腔镜下清除腹腔液及
Objective To observe the effect of laparoscopic diagnosis and treatment of pelvic endometriosis (endometriosis) and infertility. Methods A total of 314 patients diagnosed as having pelvic endometriosis by laparoscopy were divided into two groups according to the endometriosis staging system (r AFS) revised by the American Fertility Society in 1985, of which 58 cases were stage Ⅰ, 173 cases were stage Ⅱ, 68 cases and 15 cases of stage Ⅳ. Laparoscopic resection of ovarian ectopic endomembrane lesions and adhesions, pelvic peritoneal ectopic endometrial lesions within the coagulation and removal of peritoneal fluid and other surgical treatment. The patients were followed up for 36 weeks and followed up to 20 weeks of gestation. The cumulative pregnancy rates and miscarriage rates were compared between patients with different stages of AFS. Results A total of 254 pregnancies were found in 314 patients within 36 weeks after operation, which were 50 cases (86 2%, 50/58) in stage Ⅰ, 141 cases (81 5%, 14 1/173) in stage Ⅱ, , 52 cases (76.5%, 52/68) in stage III and 11 cases (73.3%, 11/15) in stage IV. The statistical tests showed that there was no significant difference in the cumulative pregnancy rates between the two groups (P> 0.05). The pregnancy rates within 24 weeks after surgery were 93.7% (2 38/2 254) After 25 to 36 weeks (63%, 16/224; P <0.01). Abortion rate was not related with stage (P> 0.05). Abortion rate (83 3%, 10/12) in pregnancy was higher than that in 12 weeks after pregnancy (16.7% , 2/12; P <0 0 5). Conclusions Laparoscopy can be used to check and diagnose the abnormalities and the pelvic factors that cause infertility in each stage. Laparoscopic surgery can improve the pregnancy rate in patients with endometriosis. Laparoscopic removal of peritoneal fluid and