Ⅰ～Ⅱ期子宫内膜异位症伴不孕腹腔镜术后应用GnRHa对妊娠的影响

Effect of GnRHa on Pregnancy Rate 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,EMs)伴不孕腹腔镜术后应用促性腺素释放激素激动剂(GnRHa)治疗对妊娠的影响。方法:对60例在清远市人民医院经腹腔镜确诊为Ⅰ～Ⅱ期EMs并排除其他不孕因素的不孕患者,按患者意愿分为GnRHa组(30例,A组)和人绝经期促性腺激素(HMG)组(30例,B组)。A组于术后第1次月经第1～3天给予GnRHa(达菲林3.75 mg)肌内注射,每28 d 1次,共3次,第3次GnRHa后40 d+HMG 37.5～112.5 IU肌内注射诱发排卵共6周期;B组于术后第1次月经第3～5天给予HMG37.5～112.5 IU肌内注射诱发排卵6周期。观察两组患者治疗1,3,6和12个月时妊娠情况以及两组患者腹腔镜术后3,6和12个月血清CA125水平和痛经情况及复发率。结果 :①A组和B组1,3,6及12个月累积临床妊娠率分别为36.6%(11/30)、56.6%(17/30)、66.7%(20/30)、76.7%(23/30)和16.7%(5/30)、30%(9/30)、36.7%(11/30)、50.0%(15/30);两组比较,A组3,6及12个月妊娠率均显著高于B组(P<0.05)。②A组术后3,6个月血清CA125水平明显低于同期B组水平,A组患者术后6,12个月痛经复发率明显低于B组。结论:Ⅰ～Ⅱ期EMs伴不孕患者经腹腔镜治疗后应用GnRHa治疗可延缓EMs的复发、提高术后妊娠率;对EMs伴不孕患者的促排卵治疗不宜超过6周期。

Objective：To investigate the effect of GnRHa on pregnancy rate in patients with stage Ⅰ-Ⅱendometriosis（EMs） associated with infertility after laparoscopy surgery.Methods：Sixty infertility patients associated with stageⅠ-Ⅱ EMs who were diagnosed and treated by laparoscopy surgery and excluded the other causes of infertility were divided into GnRHa treatment group（n=30,group A）and HMG treatment group（n=30,group B）after surgery according to the willing of the patients.The patients in group A were treated by GnRHa injection three times,fourty days after the last injection the patients were treated by HMG with the dose of 37.5-112.5 IU every day according to the patients′age and the reserve of ovarian function.At the same time,the patients in group B were directly treated by HMG with the dose of 37.5-112.5 IU every day after the surgery.The ovulation induction sycles in both groups were limited to six sycles and all the patients were followed-up for 12 months after surgery or the last GnRHa injection to evaluate the effect of the different treatments on the pregnancy rate of one month、three months、six months and twelve months.and to observe the dysmenorrheal and the serum CA125 levels in patients to evaluate the relapse rates.Results：①In group A,the clinical pregnancy rate was 36.6%（11/30）in one month;the cumulative clinical pregnancy rates were 56.6%（17/30）、66.7%（20/30） and 76.7%（23/30）in three months、six months and twelve months,respectively.In group B,the clinical pregnancy rate was 16.7%（5/30）in one month;the cumulative clinical pregnancy rates were 30%（9/30）、36.7%（11/30） and 50.0%（15/30）in three months、six months and twelve months,respectively.The cumulative clinical pregnancy rates of group A in three months,six months,twelve months were significantly higher than those of group B.②The serum CA125 levels in group A in three and six months after surgery was significantly lower than those in group B,and the dysmenorrheal recurrence rate of group A was significantly lower than that in group B in six and twelve months after laparoscopy surgery.Conclusions：GnRHa treatment after laparoscopy can delay the recurrence of EMs and can improve the pregnancy rate of patients with stage Ⅰ-Ⅱ endometriosis associated with infertility,and the ovulation induction cycles should not beyond six cycles.