腹腔镜手术联合辅助生殖技术治疗子宫内膜异位症不孕

Clinical Study of Effect of Laparoscopic Combined Assisted Reproductive Techniques Treatment on Pelvic Endometriosis-associated Infertility

目的:评价腹腔镜手术联合辅助生殖技术治疗子宫内膜异位症不孕的效果。方法:对239例子宫内膜异位症不孕患者,按照美国生育协会1985年修订的异位症分期标准(R-AFS)进行分期,其中Ⅰ期72例,Ⅱ期86例,Ⅲ期43例,Ⅳ期38例。进行腹腔镜下异位病灶电凝术、卵巢子宫内膜异位囊肿剥除术、粘连分离术、输卵管通液术及输卵管造口术,术后联合人工辅助生育技术,分析、评价疗效。结果:239例患者中术中见盆腔紫蓝色异位病灶193例,红色病灶174例,腹膜皱缩、腹膜缺损134例,盆腔粘连125例,卵巢子宫内膜异位囊肿67例,合并子宫腺肌病15例,输卵管一侧不通56例,两侧不通25例,积液21例,伞端闭锁42例。施行异位病灶电凝或内凝术193例,卵巢子宫内膜异位囊肿剥除术67例,异位病灶活检术5例,粘连分离术125例,输卵管造口术81例,同时行子宫肌瘤剥除术8例。术后根据不同情况,给予监测排卵、人工授精或体外授精-胚胎移植等措施,随访追踪,妊娠106例,妊娠率44.3%。术后给予促排卵治疗64例,其中妊娠43例,妊娠率67.2%,子宫内膜异位症复发11例,复发率17.2%;未予促排卵治疗94例,其中妊娠41例,妊娠率43.6%,子宫内膜异位症复发7例,复发率7.4%。促排卵治疗与未促排卵治疗两组的妊娠率有显著性差异(P<0.005)。两组子宫内膜异位症复发率无显著性差异(P>0.05)。结论:腹腔镜可检查、诊断各期子宫内膜异位症及其引起不孕症的盆腔因素;对输卵管通畅性作出准确评价;术后辅以辅助生殖技术,可为不孕症患者提供更多的妊娠机会,并不增加复发风险。

Objective： To investigate the role of laparoscopy combined assisted reproductive techniques in diagnosis and treatment of infertile women with endometriosis. Methods： Totally 239 infertile cases were diagnosed as having endometriosis by laparoscopy, and 72, 86, 43 and 38 cases were assigned to stage Ⅰ , Ⅱ,Ⅲ and Ⅳgroups respectively according to the revised classification American Fertility Society （r- AFS）. Laparoscopic treatment included endocoagulation of pelvic endometriosis lesions, excision of ovarian endometriosis lesions, lyses of adhesions and ravaging of the peritoneal cavity. After Laparoscopic treatment, the cases were combined with artificial auxiliary pregnancy technology. The methods included controlling ovulation, artificial insemination and in vitro fertilization -embryo transfer. Results： Of all the 239 cases, blue pathological changes could found in 193 cases, red changes in 174 cases and white changes. Adhesions in 125 cases, ovarian endometriosis cyst in 67 cases, followed with adenomyosis 15 cases. 193 cases were treated by endocoagulation of pelvic endometriosis lesions, 67 cases by excision of ovarian endometriosis lesions and 125 cases by lysis of adhesions. According to the different conktitions after Laparoscopic surgery, all the 239 cases were combined with artificial auxiliary pregnancy technology. Follow -up after Laparoscopic surgery, 106 cases became pregnant （44. 3%, 106/239）, 64 cases followed by induce ovulation, 43 cases became pregnant （67. 2%, 43/64） and 11 cases with endometriosis recurred （ 17.2%, 11/64） . 94 cases did not follow by induce ovulation, 41 cases became pregnant （43. 6%, 41/94） and 7 cases with endometriosis recurred （7.4%, 7/94） . The accumulative pregnancy rates were significantly different among the two groups （P 〈 0. 005） . The accumulative recur rates were, however, not significantly different among the two groups （ P 〉 0. 005 ） . Conclusion： Early lesions of endometriosis and pelvic factor for infertility can be found by laparoscopic surgery. Combined with artificial auxiliary pregnancy technology after laparoscopic surgery, the infertile women with endometriosis can have more pregnancy chance and not increase the recur risk.