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目的探讨探讨腹腔镜下联合药物治疗子宫内膜异位症并不孕患者的临床疗效及影响腹腔镜术后妊娠率的相关因素。方法对62例子宫内膜异位症患者行腹腔镜术,对有粘连者行盆腔粘连分解术、输卵管整形术,同时行宫腔镜检查及腹腔镜下输卵管美蓝通液术。术后给予促性腺释放激素激动剂(GnRH-a)3.75 mg皮下注射,每28 d 1次,治疗3～6个月。随访术后妊娠情况,并对相关的影响因素进行Logistic回归分析。结果 62例患者手术均获成功,无一例中转开腹,均无手术并发症。手术时间为(47.9±16.8)min,住院时间为(6.37±2.18)d,卵巢子宫内膜异位囊肿直径为(6.42±3.51)cm。r-AFS分期:子宫内膜异位症Ⅰ-Ⅱ期28例,Ⅲ-Ⅳ期34例。术后2年内妊娠率为33.8%(21/62)。多因素分析:输卵管通畅、r-AFS分期及接受助孕与患者术后妊娠率相关,为影响子宫内膜异位症不孕的主要因素;多因素logistc回归分析:对妊娠率的影响由大到小排列为术后接受助孕、输卵管通畅及r-AFS分期。结论宫腹腔镜联合药物治疗子宫内膜异位症可取得较好的妊娠结局。术后接受助孕、输卵管通畅及r-AFS临床分期是影响子宫内膜异位症不孕患者腹腔镜术后妊娠率的相关因素,临床上应加强对子宫内膜异位症并不孕患者的干预,有望提高术后妊娠率。
Objective To investigate the clinical efficacy of laparoscopic combined with drug treatment of infertility patients with endometriosis and related factors affecting the pregnancy rate after laparoscopic surgery. Methods Sixty-two patients with endometriosis underwent laparoscopy. The patients with adhesions were treated with pelvic adhesions, tubal plastic surgery, simultaneous hysteroscopy and laparoscopic tubal surgery. Postoperative gonadotropin-releasing hormone agonist (GnRH-a) 3.75 mg subcutaneously every 28 d for 3 to 6 months. Follow-up postoperative pregnancy, and related factors Logistic regression analysis. Results 62 cases of patients were successful in surgery, no case of conversion to laparotomy, no complications. The operation time was (47.9 ± 16.8) min, the hospitalization time was (6.37 ± 2.18) d, the diameter of ovarian endometriosis cyst was (6.42 ± 3.51) cm. r-AFS stage: endometriosis 28 cases of stage Ⅰ-Ⅱ, Ⅲ-Ⅳ 34 cases. The pregnancy rate was 33.8% (21/62) within 2 years after operation. Multivariate analysis showed that tubal patency, r-AFS staging and pregnancy-assisted pregnancy were related to postoperative pregnancy rate, which were the main factors influencing infertility of endometriosis. Multivariate logistic regression analysis showed that the effect on pregnancy rate was large To a small arrangement for postoperative pregnancy, tubal patency and r-AFS staging. Conclusion Laparoscopy combined with drug treatment of endometriosis can achieve better pregnancy outcomes. Postoperative postoperative pregnancy-assisted, tubal patency and clinical stage of r-AFS are related factors of pregnancy rate in patients with endometriosis infertility after laparoscopic surgery, and should be strengthened in patients with endometriosis and infertility The intervention is expected to increase postoperative pregnancy rate.