轻度子宫内膜异位症合并不孕患者术后尽早促排卵的意义

Efficiency of Postoperative Ovulation Induction on Infertile Women with Minimal-mild Endometriosis

目的探讨轻度子宫内膜异位症合并不孕患者宫、腹腔镜联合术后尽早促排卵治疗对妊娠率、流产率的影响。方法将132例轻度子宫内膜异位症合并不孕患者在宫腹腔镜手术治疗后分为实验组〔68例,于术后第一个月经周期即开始给予枸橼酸氯米芬口服促排卵,B超监测卵泡发育情况,在优势卵泡增大到直径为18～20mm时注射人绒毛膜促性腺激素(HCG)诱发排卵,并指导受孕〕和对照组(64例,术后不予促排卵,仅行期待治疗,但监测排卵、受孕指导同实验组)。随访至术后18个月末,比较两组术后一年内的妊娠率和妊娠结局。结果两组共失访6例,术后3个月内实验组与对照组妊娠率分别为37.88%、21.67%,4～6个月妊娠率分别为29.27%、19.15%,差异均有统计学意义;术后7～12个月妊娠率分别为13.79%、10.53%,差异无统计学意义;术后6月内的累计妊娠率实验组(56.06%)高于对照组(36.67%,P<0.05),两组均高于同组术后7～12月妊娠率(P均<0.05);实验组累计流产率为12.19%,低于对照组的26.92%(P<0.05);两组异位妊娠率差异无统计学意义。结论对于轻度内异症合并不孕的患者,宫腹腔镜术后及时促排卵能有效增加妊娠率,降低流产率;轻度内异症患者术后妊娠机会随时间推移逐渐降低,术后前6个月为最佳妊娠时机。

Objective To investigate the efficacy of timely ovulation induction on Infertility women with minimal-mild endometriosis （EMS） after laparoscopy combined with hysteroscopy. Methods A randomized controlled trial was performed on 132 infertility women diagnosed with minimal-mild EMS according to r-AFS by laparoscopy. They were divided into two groups after operations. The experimental group （n = 68） was administrated timely ovulation induction with clomiphene citrate tablets at the first menstrual cycle post-operation and given conceive guidance. The control group （n： 64） was treated with expectant treatment only. All the patients were followed up for 18 months after the surgery. Pregnancy rates and pregnancy outcomes within 1 year post-operation were compared between the two groups. Results During the follow up period, there were 6 cases lost. At 3 months after surgery, pregnancy rates （PR） in the experimental group and the control group were 37. 88%, 21.67% respectively; the PR at 4-6 months were 29.27%, 19.15% in the two groups respectively. The less-than- 6-months PR in the experimental group （56.06 % ） was significantly higher than that of the control group （36.67 % ） （P〈0.05）, and also higher than the PR of 7-12 months post-operation in the same group （P〈0.05）. Significant difference was found for the abortion rate between the ovulation induction group （12.19 %） and the control group （26. 92%） （P 〈 0. 05 ）. Conclusion Timely ovulation induction after laparoscopic surgery combined with hysteroscopy could significantly increase pregnancy rate and reduce abortion rate in infertility patients with minimal- mild endometriosis.