宫腹腔镜术后联合GnRH-a治疗轻中度内异症性不孕的疗效分析

Therapeutic effect of GnRH-a after laparoscopy combined with hysteroscopy for mild to moderate endometriosis-associated infertility

目的：探讨宫腹腔镜术后联合不同药物对轻、中度子宫内膜异位症（EMs）性不孕患者妊娠率的影响。方法：回顾分析2008年9月至2011年12月在我院就诊的82例Ⅱ～Ⅲ期EMs性不孕患者的临床资料，患者均行宫腹腔镜联合保留生育功能的手术。按照严格的纳入和剔除标准，筛选出有自然受孕能力的患者，术后按个人意愿用药。按患者术后用药情况分为对照组（18例）、促性腺激素释放激素激动剂组（GnRH．a，博恩诺康）（31例）和口服避孕药组（去氧孕烯炔雌醇片，妈富隆）（33例），比较3组患者在术后不同时期的妊娠率及异位妊娠的发生率。结果：博恩诺康组、妈富隆组和对照组患者术后1年内的妊娠率分别为77．42％（24／31）、51．52％（17／33）和33．33％（6／18），博恩诺康组显著高于对照组及妈富隆组（P〈0．05），而后两组则无显著差异（P〉0．05）。3组患者的异位妊娠率分别为3．23％（1／31）、6．06％（2／33）和5．56％（1／18），均无显著差异（P均〉0．05）。术后1年内，Ⅱ期EMs患者中，3组妊娠率差异显著（P=0．020）；Ⅲ期EMs患者中，3组妊娠率无显著差异（P=0．297）。II、HI期患者中，3组的异位妊娠率均无显著差异（P〉0．05）。结论：宫腹腔镜术后联合博恩诺康有利于改善轻、中度EMs性不孕患者的生育能力。

Objective：To evaluate the therapeutic effictiveness of GnRH-a after lapa- roscopy combined with hysteroscopy for mild to moderate endometriosis-assoeiated infertility. Methods：We retrospectively analyzed the clinical data of infertile women with Ⅱ - m stage of EMs who were treated in our hospital from Sep. 2008 to Dec. 2011.82 patients underwent lapa- roseopy combined with hysteroscopy surgery to preserve fertility. According to the strict inclu- sion and exclusion criteria, scelected patients who can pregnancy naturally. After surgery ac- cording to the wishs of the individual to choose a different drug or no drugs. The patients were divided into control group, Gonadotrophin-Releasing Hormone Analogue （GnRH-a, Boennuo- kang） group and the OCPs （Desogestrel and Ethinylestradiol Tablets, Marvelon ） group. The pregnancy rate and ectopic pregnancy incidence were observed after the surgery. Results：After one year, the conception rates of the Boennuokang group, Marvelon and control group were 77.42% （24/31） ,51.52% （ 17/33 ） and 33.33% （6/18） respectively. The pregnancy rate in Boennuokang group was significantly higher than that in the control group and the Marvelon group （ P〈0.05 ）. There was no statistically significant differences between the Marvelon groups and the control group. 1 year after surgery, II stage EMs patients in three group difference in pregnancy rate was significantly（P〈O. 05）. m stage EMs patients in each group had no signifi- cant difference in pregnancy rate（P〉0.05 ）. Ⅱ stage, Ⅲ stage between the groups of patients the incidence of ectopic pregnancy was no significant difference （ P〉0.05 ）. Conclusion ： Afterlaparoscopy combined hysteroscopy with the Boennuokang will help to improve the fertility of patients with mild to moderate endometriosis-associated infertility.