子宫内膜异位症合并内膜息肉宫、腹腔镜联合手术后的自然妊娠结局

Natrual Pregnancy Outcomes of Hysteroscopy Combined with Laparoscopic Surgery for Infertile Patients with Endometriosis and Endometrial Polyps

目的探讨子宫内膜异位症合并不孕症患者子宫内膜息肉的发病特点和宫、腹腔镜联合手术后的自然妊娠情况。方法回顾性分析2010年1月～2012年12月我院生殖中心接受宫、腹腔联合手术治疗、病理证实的252例子宫内膜内异症合并不孕患者的临床资料，按是否合并子宫内膜息肉分为息肉组（71例）和非息肉组（181例）。结果子宫内膜息肉的患病率为28．2％（71／252），明显高于同期非内异症不孕人群的17．4％（464／2675），差异有统计学意义（Z=-18．107，P=0．000）。子宫内膜息肉在卵巢型、单纯腹膜型和累及Douglas窝的深部浸润型内异症（deep infiltrating endometriosis，DIE）中的发生率分别为22．1％（17／77）、28．o％（42／150）和48．0％（12／25），3种类型子宫内膜息肉的发生率有统计学差异（x2=6．247，P=0．044）。息肉组术后自然妊娠率为32．4％（23／71）、临床妊娠率为26．8％（19／71）、分娩率为25．4％（18／71），均分别低于非息肉组35．4％（64／181）、33．7％（61／181）、26．0％（47／181），但均无统计学差异（Z=-0．444，P=0．657；Z=-1．063，P：0．288；Z=-0．100，P=0．920）；息肉组胚胎停育率5．6％（4／71）明显高于非息肉组0（Z=-3．213，P：0．001）。结论子宫内膜息肉在内异症合并不孕患者中的患病率明显升高，尤其在累及子宫直肠窝的DIE患者中表现更突出。子宫内膜息肉对子宫内膜容受性的影响在息肉去除后可能仍然存在。

Objective To investigate the pregnancy outcomes of hysteroscopy combined with laparoscopic surgery for infertile patients with endometriosis and endometrial polyps. Methods The clinical data of 252 female patients with infertility undergoing laparoscopic and hysteroscopic surgery in our reproductive center from January 2010 to December 2012 were retrospectively analyzed. The pelvic endometriosis was all confirmed by pathology and surgery. The patients were divided into endometrial polyps group and non- endometrial polyps group. Results The incidence of endometrial polyps was 28.2% （71/252） , which was higher than that of the non-cndometriosis infertile patients in the same period （17. 4%, 464/2675; Z = -18. 107, P = 0. 000）. The incidences of endometrial polyps were as follows： ovarian, 22.1% （17/77） ; single peritoneal, 28.0% （42/150） ; and DIE, 48.0% （ 12/25 ）. There was a statistical difference in the incidences among the three types （X2 = 6. 247, P = 0. 044）. The postoperative pregnancy rates in endometrial polyps group were as follows： natural fertilization, 32.4% （23/71） ; clinical pregnancy, 26. 8% （ 19/71 ） ; and delivery rate, 25.4% （18/71）. All of them were lower than those of the non-polyps group which were 35.4% （64/181）, 33.7% （61/181 ） and 26.0% （47/181 ） , respectively, and there were no significant differences between the two groups （Z =-0. 444, P = 0.657;Z= -1.063, P=0.288;Z= -0. 100, P=0.920）. However, the rate of spontaneous abortion was higher than that of the non-polyps group （5.6% vs. 0, Z = - 3. 213, P = 0. 001 ）. Conclusions There is a higher incidence of endometrial polyps among patients with endometriosis and infertility, especially for patients with lesions on the Douglas. The impact of endometrial polyps on endometrial receptivity may remain even after the removal of polyps.