腹腔镜联合药物治疗子宫内膜异位症合并不孕的临床分析

Clinical Study of Laparoscopic Operations Combined With Endocrinal Therapy on Endometriosis Associated With Infertility.

目的探讨腹腔镜联合药物治疗子宫内膜异位症(endometriosis,EM)合并不孕的临床价值。方法选择2003年1月至2007年1月本院收治的Ⅰ～Ⅳ期子宫内膜异位症合并不孕患者341例为研究对象。对其在腹腔镜下子宫内膜异位症类型分别行粘连松解术、异位病灶电凝术、卵巢子宫内膜异位囊肿切除术、输卵管造口及通液术后,将各期患者随机分为A,B组和对照组。A组(n=93)口服孕三烯酮(内美通,2.5 mg/粒,每周2次,每次1粒),疗程为6个月。B组(n=114)肌内注射醋酸曲普瑞林(达菲林,规格:3.75 mg/支,每4周1次,每次1支),疗程3个月,对照组(n=134)未用药。治疗后,随访1年,比较三组的妊娠结局。结果对于Ⅰ,Ⅱ期子宫内膜异位症合并不孕患者,A,B组平均受孕率为39.2%,对照组受孕率为30.1%,A,B组与对照组比较,差异无显著意义(P>0.05)。对于Ⅲ,Ⅳ期子宫内膜异位症合并不孕患者,A,B组平均受孕率为37.5%,对照组受孕率为23.0%,A,B组与对照组比较,差异无显著意义(P>0.05);且B组受孕率(45.6%)高于A组(28.3%),两组比较,差异有显著意义(P<0.05)。结论腹腔镜手术治疗,可提高子宫内膜异位症合并不孕患者的妊娠率,对于Ⅲ期、Ⅳ期的子宫内膜异位症合并不孕患者,腹腔镜术后联合药物治疗对提高妊娠率有重要作用。促性腺激素释放激素激动剂是腹腔镜术后联合药物治疗的最好选择。

Objective To study the clinical value of laparoscopic operation combined with endocrinal therapy on endometriosis associated with infertility. Methods From January 2003 to January 2007, a total of 341 cases of endometriosis（EM） associated with infertility who were underwent laparoscopic operations were included in this study. After the laparoscopic operation, they were divided into 3 groups, without endocrinal therapy group （control group, n= 134）, treated with gestrinone group （group A, n=93）, and treated with gonadotropin releasing hormone analogues （GnRHa） group （group B, n= 114）. Results In the cases of stage Ⅰ and Ⅱ , the pregnancy rate was 30.1% in control group and the average pregnant rate was 39.2% in group A and 13. There had no significant difference among three groups （P〉0.05）. In the cases of stage Ⅲ and Ⅳ , the average pregnancy rates were 23.0% and 37.50% in control group and group B, C, respectively. There had no significant difference among three groups （P〉0.05）. The average pregnancy rate of group B （45. 6%） was significant high than that of group A （28.3%） （P〈0.05）. Conclusion Laparoscopic operation can be used in the treatment of endometriosis associated with infertility. In the cases of stage Ⅲ and Ⅳ, laparoscopic operation combined with post-operative endocrinal therapy is of importance effects, and gonadotropin releasing hormone analogues is the best choice.