应用腹腔镜诊断和治疗子宫内膜异位症及不孕症的疗效

Clinical study of effect of laparoscopic diagnosis and treatment on pelvic endometriosis associated infertility

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。

Objective To investigate the role of laparoscopy in diagnosis and treatment of infertile women with endometriosis Methods Totally 314 infertile cases were diagnosed as having endometriosis by laparoscopy,and 58,173,68 and 15 cases were assigned to stage Ⅰ,Ⅱ,Ⅲ and Ⅳ groups respectively according to the revised classification American Fertility Society (r AFS) Laparoscopic treatment included excision of ovarian endometriosis lesions, lysis of adhesions, endocoagulation of pelvic endometriosis lesions with controlled heating (100℃) and lavaging of the peritoneal cavity The duration of follow up after laparoscopic surgery was censored at 36 weeks Women who became pregnant were followed up to 20 weeks′ gestation The U and χ 2tests were used to determine significance of difference in the rate of pregnancy and spontaneous abortion between all clinical stages Results Of all the 314 cases,254 became pregnant within 36 weeks after surgery The cumulative numbers of pregnancy were 50(86 2%,50/58), 141(81 5%,141/173), 52(76 5%,52/68) and 11(73 3%,11/15) in stage Ⅰ Ⅳ groups respectively The accumulative pregnancy rates were, however, not significantly different among stages Ⅰ Ⅳ ( P >0 05) The accumulative pregnancy rate within 24 weeks after surgery (93 7%,238/254) was higher than that within 25 36 weeks after surgery (6 3%,16/254) Of 254 cases who were pregnant,12 had miscarriage There was no significant difference of miscarriage rate between all stages ( P >0 05) While the rate of miscarriage was higher within 12 weeks of gestation (83 3%,10/12) than that of after 12 weeks of gestation ( P <0 05) Conclusions Early lesions of endometriosis and pelvic factors for infertility can be found by laparoscopy And pregnancy rate of endometriosis associated infertility can be improved by laparoscopic surgery To clean the menstrual blood pool and ablate peritoneal lesion with endocoagulation as completely as possible have significant importance for enhancement of fecundity in infertile women with endometriosis, especially for stage Ⅰ Ⅱ cases