子宫内膜异位症不育患者腹腔镜术后不同治疗方法预后比较

Comparison of different therapeutic protocols in the treatment of infertility associated with endometriosis after laparoscopic surgery

目的回顾性比较分析子宫内膜异位症(内异症)不育患者腹腔镜术后不同治疗方法的预后。方法 1997年7月至2007年12月在江苏省人民医院因不育经腹腔镜检查证实为内异症的患者179例,男方精液异常者不包括在内。轻型Ⅰ、Ⅱ期患者分为A组62例辅助生育治疗(ART组),其中行官腔内人工授精(IUI)治疗17例、体外受精(IVF)45例,B组35例期待治疗(NART组)两组;重症型Ⅲ、Ⅳ期患者分为C组55例ART组,其中IUI17例、IVF38例,D组27例NART组两组。根据输卵管通畅情况、患者年龄、不孕年限、内异症分期及评分将双侧通畅组、单侧通畅组分别行NART、ART治疗的患者进行配对比较,进行随访,随访时间截止2008年4月,将随访结果进行统计分析。结果 A、B、C、D组累计妊娠率分别为56.5%、45.7%、45.5%、44.4%,各组之间累计妊娠率无明显差异。术后妊娠88例,其中术后1年内妊娠者84例;1年后妊娠者仅为4例(P<0.001)。术后各组的复发率分别为4.8%、11.4%、29.1%和33.3%,A与B组间、C与D组间复发率无明显差异,但C、D组较A、B组复发率明显升高(P<0.05)。双侧输卵管通畅分别行NART、ART的配对组的比较中,轻症内异症行ART或期待疗法的妊娠率无明显差异,而重症内异症行ART较期待治疗妊娠率明显升高(P<0.05)。结论对于轻症内异症,术后采取ART与NART妊娠率无明显差异,但重症内异症术后行ART是一种更积极的获得妊娠的方法。内异症术后复发率与手术的分期密切相关,重症内异症复发率更高。

Objective： To analyze the prognosis of different with endometriosis after laparoscopic surgery. therapeutic protocols in infertile patients associated Methods： A total of 179 infertile women with endometriosis confirmed and treated by laparoscopy were included in this study. There were no semen abnormalities in their partners. Patients at stage I or II of endometriosis were assigned to Group A （62 patients, assisted reproductive technology （ART） group） and Group B （35 patients, expectant （NART） group） ; patients at stage III or IV were assigned into Group C （55 patients, ART Group） and Group D （27 patients, NART group）. And according to the tubal patency, patients were also divided into bilateral tubal patency group, unilateral tubal patency group and bilateral tubal occlusion group. According to patients＇ age, duration of infertility, stage and score of endometriosis, matched patients with bilateral tubal patency in ART and NART group were paired and followed up. Our follow-up ended in April 2008. Follow-up results were analyzed. Results： The cumulative pregnancy rates of Group A, B, C and D were 56.5 %, 45.7 %, 45.5 % and 44.4 %, respectively, with no significant difference between groups. Among 88 women who achieved pregnancy after operation, 84 get pregnant within 1 year and only 4 later than 1 year （P〈0. 001） . The recurrence rates of endometriosis were 4.8%, 11.4%, 29.1% and 33.3% in Group A, B, C and D, respectively, with no significant difference between group A and B or between Group C and D. But the recurrence rates in Group C and D were significantly higher than in Group A and B （P〈0.05）. In the paired comparison for those with bilateral tubal patency, the pregnancy rates in the mild endometriosis patients with ART or NART were similar, while in the patients with severe endometriosis, the pregnancy rate in ART group was significantly higher than that in NART group （P〈0.05）. Conclusions： For the patients with mild endometriosis, either ART or expectant treatment can be chosen after laparoscopic treatment. For those with severe endometriosis, ART should be more effective in achieving pregnancy. The recurrence rate of endometriosis is closely correlated with the stage of the dis ease and severe case has a higher recurrence rate.