子宫内膜异位症患者术后不孕原因分析

Etiological Study on Postoperative Infertility in Endometriosis Patients

目的 :分析子宫内膜异位症伴不孕患者腹腔镜术与开腹手术后仍然不孕的原因。方法 :选择 10 3例有手术指征的子宫内膜异位症伴不孕患者 ,分为腹腔镜与开腹手术两组进行手术治疗 ,术后口服孕三烯酮 3～ 6个月 ,随访患者 2年内妊娠情况 ,分析术后不孕的原因。结果 :子宫内膜异位症伴不孕患者腹腔镜术后 2年内妊娠率为 5 5 .2 0 % ,开腹手术 5 0 .0 0 % ,总妊娠率为5 2 .74 % ,两组妊娠率差异无显著性 (P >0 .0 5 ) ;子宫内膜异位症分期程度与输卵管通畅程度差异无显著性 (P >0 .0 5 )。术后不孕原因中 ,输卵管不通占 37.2 1% (16 / 4 3) ,子宫腺肌病 13.95 % (6 /4 3) ,子宫内膜异位症复发 9.30 % (4/ 4 3) ,子宫内膜异位症合并子宫肌瘤 6 .98% (3/ 4 3) ,既往有两次开腹史者 4 .6 5 % (2 / 4 3)。另外还有 2 7.91% (12 / 4 3)输卵管通畅但不孕原因未明。结论 :治疗子宫内膜异位症伴不孕应选手术治疗 ,有条件首选腹腔镜手术 ;术后不孕与输卵管不通关系密切 ,子宫内膜异位症合并子宫肌瘤及腺肌病等也是不孕的原因。

Objective: To look into the reasons of postoperative infertility in the infertile patients with endometriosis treated by laparoscopic operation (LO) or abdominal operation (AO). Methods: 103 infertile subjects with endometriosis were selected and divided into two groups for either LO or AO treatment. After operation, all patients took Gestrinone for 3-6 months and were followed-up for two years. For those cases with postoperative infertility, the etiological factors were analyzed. Results: During the first two years after operation, the total gravid rate was 52.74% in these 103 patients. The gravid rate was 55.20% in LO group and 50.00% in AO group, which had no significant difference between them (P>0.05); there was no close association between fallopian impediment and rAFS staging of endometriosis (P>0.05). Among those patients with postoperative infertility, 37.21% (16/43) of them were caused by the fallopian impediment; 13.95% (6/43) by uterus adenomyosis, 9.30% (4/43) by recurrence of endometriosis, 6.98% (3/43) by uterus myoma, 4.65% (2/43) by two times of trans-abdominal operation, and in addition, 27.91% (12/43) by unclear reasons but with unobstructed fallopian tubes. Conclusions: The operative therapy should be chosen for infertile patients with endometriosis and LO to be the first choice if it is available. The fallopian impediment is the most important cause for the postoperative infertility. Other reasons include recurrent endometriosis companied with uterus myoma, adenomyosis, etc.