腹腔镜手术治疗子宫内膜异位症不孕效果分析

Study of curative effects of laparoscopic treatment in endometriosis-associated infertility

目的 研究腹腔镜手术治疗子宫内膜异位症不孕的效果.方法 对湖北省潜江市中心医院201 1年9月至2013年9月收住院的83例子宫内膜异位症并不孕患者进行回顾性分析.结果 在子宫内膜异位症引起不孕症的盆腔病变中,Ⅰ～Ⅱ期患者主要病变为异位内膜累及盆腔腹膜,形成腹膜病灶,Ⅲ～Ⅳ期患者主要病变为异位内膜累及卵巢引起卵巢囊肿及卵巢输卵管周围粘连;术后0～24周妊娠率为62.7％ （52/83）,Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为73.9％（17/23）、58.8％（20/34）、60.0％（12/20）、50.0％（3/6）;术后25 ～36周妊娠率为4.8％（4/83）,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为0（0/23）、5.9％ （2/34）、5.0％（1/20）、16.7％（1/6）.术后24周内妊娠率明显高于术后25 ～ 36周,差异有统计学意义（P＜0.05）;Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者术后症状的缓解率分别为87.7％（50/57）和76.9％（20/26）,二者差异无统计学意义,Ⅲ～Ⅳ期复发率为19.2％（5/26）,明显高于Ⅰ～Ⅱ期的1.8％（1/57）,差异有统计学意义（x2=16.11,P＜0.05）.结论 腹腔镜手术治疗子宫内膜异位症并不孕效果明确,疗效显著.

Objective To study the curative effects of laparoscopic treatment in endometriosis-associated infertility.Methods Totally 83 infertile women with endometriosis treated with laparoscopic between September 2011 and September 2013 were assigned to stage Ⅰ,Ⅱ,Ⅲ and Ⅳ groups respectively.Results In stage Ⅰ-Ⅱ patients,the main pelvic lesions were involvement of pelvic peritoneum,while in stage Ⅲ-Ⅳ patients,the main pelvic lesions were ovarian cyst and adhesion around the fallopian tube.Pregnancy rate of postoperative 24 weeks was 62.7%,pregnancy rate of phase Ⅰ,Ⅱ,Ⅲ and Ⅳ was 73.9% （17/23）,58.8% （20/34）,60.0% （12/20）,50.0% （3/6）,respectively; pregnancy rate of postoperative 25-36 weeks was 4.8%,pregnancy rate of phase Ⅰ,Ⅱ,Ⅲand Ⅳ 0 （0/23）,5.9% （2/34） and 5.0% （1/20）,16.7% （1/6）,respectively.The pregnancy rate after surgery within 24 weeks was significantly higher than that within 25-36 weeks （P 〈 0.05）.The reoccurrence rate of stage Ⅲ-Ⅳ patients was significantly higher than that of stage Ⅰ-Ⅱ patients [87.7% （50/57） vs 76.9% （20/26）] （P 〈0.05）,while there was no significant difference among stage Ⅰ-Ⅱ and Ⅲ-Ⅳ patients [19.2% （5/26） vs 1.8% （1/57）] （x2 =16.11,P 〈 0.05）.Conclusion For patients with endometriosis-associated infertility,laparoscopic treatment is effective with a high pregnant rate after infertility.