腹腔镜手术联合GnRH-a治疗卵巢巧克力囊肿合并不孕临床分析

Clinical analysis on ovarian chocolate cyst combined with infertility treated with laparoscopic surgery combined with GnRH-a

目的:分析单纯腹腔镜保守手术及手术联合GnRH-a治疗巧克力囊肿合并不孕的治疗效果及对妊娠的影响。方法:回顾性分析153例巧克力囊肿(卵巢子宫内膜异位症)伴不孕患者行腹腔镜手术术后随访资料,按照术后是否使用GnRH-a将其分为两组,52例患者(观察组)术后使用GnRH-a,其余101例患者(对照组)术后鼓励其生育,比较两组的妊娠率和复发率。结果:所有患者总妊娠率为31.37%。对照组的妊娠率为27.72%,观察组的妊娠率为37.74%,观察组的妊娠率高于对照组,差异无统计学意义(P>0.05);对照组Ⅰ～Ⅱ期患者的妊娠率为36.54%,观察组Ⅰ～Ⅱ期患者的妊娠率为40.00%,差异无统计学意义(P>0.05);对照组和观察组Ⅲ～Ⅳ期患者的妊娠率分别为18.37%和37.84%,两者比较差异有统计学意义(P<0.05)。对照组的复发率为14.41%,高于观察组(6.52%),两组比较差异有统计学意义(P<0.05)。结论:腹腔镜保守手术后联合GnRH-a可短期内降低或延迟复发,对于Ⅰ～Ⅱ期患者,术后使用GnRH-a不能提高妊娠率,应鼓励其尽快受孕,Ⅲ～Ⅳ期患者术后使用GnRH-a可提高妊娠率。

Objective： To analyze the curative effect of laparoscopic conservative surgery and surgery combined with GnRH - a for treatment of chocolate cyst compined with infertility and the impact on pregnancy. Methods： The clinical data of 153 eases with chocolate cysts （ovarian endometriosis） combiend with infertility treated by laparoscopic surgery were analyzed retrospectively, then they were divided into two groups according to whether postoperative GnRH -a was used, 52 patients （experimental group） were selected and GnRH -a was applied after surgery, and the other 101 patients （control group） were encouraged to give birth to their babies. The pregnancy and relapse rates in the two groups were compared. Results： The pregnancy rate of all the patients was 31.37%. The pregnancy rate in control group was 27.72% and the pregnancy rate in experimental group was 37.74%. The pregnancy rate in experimental group was higher than that in con- trol group, but there was no significant difference （P 〉 0. 05 ） . At I and Ⅱ stages of the experiment, the pregnancy rate in control group was 36. 54% and the pregnancy rate in experimental group was 40. 00% , but there was no significant difference （P 〉0. 05） . At Ⅲ and stages of the experiment, the pregnancy rate in control group and experimental group were 18. 37% and 37.84%, respectively, there was statistically significant difference （ P 〈 0. 05 ） . The recurrence rate in control group was 14.41% , which was higher than that in experimental group （6. 52% ） , there was statistically significant difference （P 〈 0. 05） . Conclusion： Laparoscopic surgery combined with GnRH - a can reduce or delay recurrence in a short time. As to the patients of stages I and Ⅱ , it is recommended to get pregnancy as soon as possible be- cause the usage of GnRH - a can not improve the pregnancy rate. But the pregnancy rates of the patients at stage Ⅲ and IV- can be improved when using GnRH- a.