Ⅰ～Ⅱ期子宫内膜异位症伴不孕腹腔镜术后三种辅助治疗的疗效对比研究

Effeciency of three different additional treatments in patients with stage Ⅰ～Ⅱ endometriosis associated with infertility after laparoscopy surgery

目的探讨Ⅰ～Ⅱ期子宫内膜异位症(Endometriosis,EMT)伴不孕腹腔镜术后三种不同辅助治疗对妊娠的影响。方法对2009年6月～2010年12月90例在我院经电视腹腔镜检查并确诊为Ⅰ～Ⅱ期EMT并排除其他不孕因素的不孕患者,经宫腔镜检查及腹腔镜盆腔内异症病灶电凝术后,根据患者意愿分为期待组(30例,A组)、HMG促孕组(30例,B组)和散结镇痛胶囊+HMG促孕组(30例,C组);随访12个月,追踪1)三组患者治疗3个月、6个月及12个月妊娠情况;2)三组患者腹腔镜术后3、6、12个月Ca125及痛经情况,统计复发率。结果 1)A、B、C三组3、6、12个月累积临床妊娠率分别为:13.3%(4/30)、23.3(7/30)、26.7(8/30);30%(9/30)、36.7%(11/30)、50%(15/30);33.3%(10/30)、43.3(13/30)、56.7(17/30)。三组两两组比较,A组12个月累积临床妊娠率均低于B组和C组,差异具有统计学意义(P<0.05);B组和C组相比,3、6及12个月妊娠率均无明显差异。2)A、B、C三组术后12个月C组患者EMT复发率明显低于A组和B组。结论Ⅰ～Ⅱ期EMT伴不孕患者经腹腔镜治疗后应用HMG促孕治疗可提高术后妊娠率;散结镇痛胶囊对延缓EMT复发具有一定的疗效。

Objective To investigate the efficiency of three different additional treatments in patients with stage Ⅰ-Ⅱ endometriosis associated with infertility after laparoscopy surgery. Methods From Jun. 2009 to Dec. 2010, ninty infertility patients associated with stage Ⅰ-Ⅱ endometriosis who were diagnozed and treated by laparoscopy surgery and excluded the other causes of infertility were divided into three groups： expectant management group（n= 30, group A）;HMG treatment group （n= 30, group B） ;Sanjiezhengtong Capsules and HMG treatment group（n= 30, group C） after surgery according to the willing of the patients. All the patients were followed-up for 12 months after surgery to evaluate the efficiency of the three different additional treatments on the pregnancy rates of three months, six months and twelve months, and observed the dysmenorrheal and the serum Ca125 levels in patients to evaluate the relapse rates. Results ①. The cumulative clinical pregnancy rates in A, B, C group in three months, six months and twelve months were 13.3% （4/30）, 23.3 （7/30）, 26.7（8/30） ; 30%（9/30）, 36.7%（11/30）, 50%（15/30）;33.3%（10/30）, 43.3（13/30）, 56.7（17/30）respectively. Compared with each other, the cumulative clinical pregnancy rates of group A in twelve months were significantly lower than those of group B and group C, and there was no significant difference in group B and group C.②The relapse rate of group C was significant lower than those of group A and group B. Conclusions HMG treatment after laparoscopy can improve the pregnancy rate of patients with stage Ⅰ-Ⅱ endometriosis associated with infertility, and Sanjiezhengtong Capsules can delay the recurrence of EMT.