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目的回顾性比较分析子宫内膜异位症(内异症)不育患者腹腔镜术后不同治疗方法的预后。方法 1997年7月至2007年12月在江苏省人民医院因不育经腹腔镜检查证实为内异症的患者179例,男方精液异常者不包括在内。轻型Ⅰ、Ⅱ期患者分为A组62例辅助生育治疗(ART组),其中行官腔内人工授精(IUI)治疗17例、体外受精(IVF)45例,B组35例期待治疗(NART组)两组;重症型Ⅲ、Ⅳ期患者分为C组55例ART组,其中IUI17例、IVF38例,D组27例NART组两组。根据输卵管通畅情况、患者年龄、不孕年限、内异症分期及评分将双侧通畅组、单侧通畅组分别行NART、ART治疗的患者进行配对比较,进行随访,随访时间截止2008年4月,将随访结果进行统计分析。结果 A、B、C、D组累计妊娠率分别为56.5%、45.7%、45.5%、44.4%,各组之间累计妊娠率无明显差异。术后妊娠88例,其中术后1年内妊娠者84例;1年后妊娠者仅为4例(P<0.001)。术后各组的复发率分别为4.8%、11.4%、29.1%和33.3%,A与B组间、C与D组间复发率无明显差异,但C、D组较A、B组复发率明显升高(P<0.05)。双侧输卵管通畅分别行NART、ART的配对组的比较中,轻症内异症行ART或期待疗法的妊娠率无明显差异,而重症内异症行ART较期待治疗妊娠率明显升高(P<0.05)。结论对于轻症内异症,术后采取ART与NART妊娠率无明显差异,但重症内异症术后行ART是一种更积极的获得妊娠的方法。内异症术后复发率与手术的分期密切相关,重症内异症复发率更高。
Objective To retrospectively compare the prognosis of different treatment methods of laparoscopic surgery for infertility patients with endometriosis (endometriosis). Methods From July 1997 to December 2007, 179 cases of endometriosis confirmed by infertility and laparoscopy in Jiangsu Provincial People’s Hospital were excluded from the study. The patients with stage Ⅰ and Ⅱ were divided into two groups: ART group (62 cases), AR group (17 cases), IVF group (45 cases) and B group (35 cases) ). The patients with severe stage III and IV were divided into 55 ART patients in C group, including 17 cases of IUI, 38 cases of IVF and 27 cases of NART in D group. According to the tubal patency, patient’s age, duration of infertility, endometriosis staging and grading, patients with bilateral patency group and unilateral patency group were treated with NART and ART respectively. The patients were followed up and were followed up until April 2008 , The follow-up results for statistical analysis. Results The cumulative pregnancy rates in groups A, B, C and D were 56.5%, 45.7%, 45.5% and 44.4%, respectively. There was no significant difference in cumulative pregnancy rates among groups. There were 88 cases of postoperative pregnancy, of which 84 cases of pregnancy within 1 year after surgery; only 4 cases of pregnancy after 1 year (P <0.001). The recurrence rates of the groups after operation were 4.8%, 11.4%, 29.1% and 33.3% respectively. There was no significant difference between groups A and B and between groups C and D, but the recurrence rates of groups C and D were higher than those of groups A and B Was significantly higher (P <0.05). Bilateral tubal patency were NART, ART paired group comparison, mild endometriosis ART or expectant care pregnancy rate was no significant difference, while severe endometriosis ART than expectant treatment pregnancy rate was significantly increased (P <0.05). Conclusions There is no significant difference in the pregnancy rate between ART and NART for mild endometriosis, but ART is a more active method of obtaining pregnancy after severe endometriosis. The recurrence rate of endometriosis is closely related to the stage of surgery, and the recurrence rate of severe endometriosis is higher.