腹腔镜手术治疗子宫内膜异位症伴不孕104例

Laparoscopy for Endometriosis Complicated with Infertility:Report of 104 Cases

目的探讨腹腔镜手术治疗子宫内膜异位症伴不孕的妊娠结局及影响术后妊娠的有关因素。方法我院2006年1月-2007年1月对子宫内膜异位症合并不孕104例（r-AFS分期：Ⅰ期19例、Ⅱ期15例、Ⅲ期36例、Ⅳ期34例）,均行腹腔镜下子宫内膜异位囊肿剥除术及盆腔腹膜内异灶减灭术,对有粘连者行盆腔粘连分解术,同时通过宫腔镜经子宫向输卵管注入亚甲蓝液,行输卵管通液检查了解输卵管通畅情况,对输卵管不通或通而不畅的患者进行输卵管整形术以恢复其功能。术后均服用孕三烯酮3-6个月,随访术后妊娠情况。结果104例腹腔镜手术均成功完成。术后妊娠率38.5%（40/104）,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期子宫内膜异位症术后妊娠率分别为42.1%（8/19）、40.0%（6/15）、36.1%（13/36）、38.2%（13/34）,差别无统计学意义（χ^2=0.206,P=0.977）。单纯卵巢巧克力囊肿术后妊娠率为54.8%（23/42）,卵巢巧克力囊肿同时合并其他部位和仅其他部位内膜异位症术后妊娠率分别为22.9%（8/35）和33.3%（9/27）,差异有统计学意义（χ^2=8.616,P=0.013）。右侧卵巢巧克力囊肿术后妊娠率为81.3%（13/16）,高于左侧35.7%（5/14）和双侧41.7%（5/12）（χ^2=7.412,P=0.025）。结论腹腔镜手术治疗子宫内膜异位症合并不孕有较好的妊娠结局,r-AFS分期可能对术后妊娠无明显影响,内异症病灶部位、巧克力囊肿侧别可能与术后妊娠有关。

Objective To investigate the outcomes of laparoscopic surgery for endometriosis complicated with infertility and the related factors influencing the post-treatment pregnancy. Methods Between January 2006 and January 2007, 104 patients with endometriosis complicated with infertility, including 19 r-AFS stage I cases, 15 stage II cases, 36 stage III cases, and 34 stage IV cases, were treated in our hospital. The ectopic endometrial tissues were removed by laparoscopy in all of the patients. And adherent tissues were freed at the mean time. After the procedures, Methylene blue was used to test the potency of the Fallopian tubes. For cases with obstructed Fallopian tubes, salpingoplasty was performed as well. After the operation, the patients received gestrinone therapy for 3 to 6 months and were followed up for pregnancy rate. Results The laparoscopic procedures were completed in all of the 104 cases. The post-operational rate of pregnancy was 38.5% （40/104）. In women with stage I endometriosis, the pregnancy rate was42.1% （8/19）, while in the stages II,III, and IV, the rate was 40.0% （6/15）, 36.1% （13/36）, and 38.2% （13/34）, respectively （χ^2 = 0. 206, P = 0. 977）. The pregnancy rate of the patients with single ovarian chocolate cyst was 54.8% （23/42）, and that in the patients with chocolate cyst complicated with ectopic endometrium in other positions or those without chocolate cyst were 22.9% （8/35） and 33. 3% （9/27） respectively （χ^2 = 8. 616,P = 0. 013 ）. The postoperative pregnancy rate of the patients with chocolate cyst in the right ovary [81.3% （13/16）] was significantly higher than that in the cases with left chocolate cyst [ 35.7% （5/14） ] or chocolate cyst in both sides [41.7% （5/12） ] （χ^2 = 7. 412, P =0. 025）. Conclusions Laparoscopy is effective for endometriosis complicated with infertility with high post-operative pregnancy rate. EMT stages show no effect on the pregnancy rate, which may be associated with the position of ectopic endometrium and the side of chocolate cysts.