子宫内膜异位症不孕患者术后应用促性腺激素释放激素激动剂对妊娠结局的疗效观察

Effect of Laparoscopic Surgery Combined with the Following Treatment of Gonadotropinreleasing Hormone Agonist on the Patients with Eendometriotic Infertility

目的观察子宫内膜异位症不孕患者腹腔镜术后联合促性腺激素释放激素激动剂（Gn RH-a）的疗效及子宫内膜异位症症生育指数（EFI）对妊娠结局的预测价值。方法 2005年1月-2011年7月对接受腹腔镜手术治疗的125例子宫内膜异位症不孕患者的资料进行回顾性分析,并计算EFI。依据术后辅助治疗情况,将治疗结束后的患者分为2组：对照组为单纯腹腔镜手术治疗组;Gn RH-a组为腹腔镜术后联合Gn RH-a治疗组。观察两组患者治疗后的自然妊娠率,以及不同EFI分值的患者治疗后的自然妊娠率。结果103例完成随访,其中对照组48例,Gn RH-a组55例。治疗后半年、1年和3年的累计妊娠率在对照组分别为12.5%、31.2%和41.7%,Gn RH-a组分别为0%、16.3%和40.0%,两组间1年和3年累计妊娠率比较差异无统计学意义（P〉0.05）。Gn RH-a组55例,几乎均发生了不同程度的药物不良反应,但无严重不良反应发生,停药后不良反应均消失。EFI 8-10分的患者1年和3年累计妊娠率分别为31.3%和62.5%;EFI 5-7分的患者1年和3年累计妊娠率分别为15.2%和26.0%;EFI0-4分的患者9例,术后1例未用药,其余8例均使用Gn RH-a治疗,均未妊娠。EFI分值同患者1年和3年累计妊娠率呈正相关（rs=0.204,P=0.039;rs=0.437,P〈0.001）。结论与单纯腹腔镜手术相比,术后辅助Gn RH-a治疗不能提高自然妊娠率,并使妊娠时机延后,增加药物不良反应;EFI可以有效预测治疗后的自然妊娠率,EFI评分8分以上患者治疗后可以短期期待,EFI评分7分以下治疗后自然妊娠率较低,建议尽快辅助生殖。

Objective To investigate the effect of laparoscopic surgery combined with the following treatment of gonadotropin-releasing hormone agonist（Gn RH-a） on the patients with endometriotic infertility and the value of endometriosis fertility index（EFI） system on forecasting the pregnancy outcome.Methods From January 2005 to July 2011,the clinical data of 15 patients with endometriotic infertility patients were analyzed retrospectively.All the patients underwent laparoscopic surgery,and the effect was evaluated according to the endometriosis fertility index（EFI）.Then all the patients were divided randomly into two groups on the basis of the different assisted treatment after the laparoscopic surgery： the control group（without any other therapy） and the Gn Rh-a group（combined with Gn RH-a）.Eventually,the pregnant rates were calculated respectively in the different groups or according to the different EFI.Results At last,103 cases finished the follow-up.The pregnancy rate in the control group after 6 months,1 year and 3 years therapy were 12.5 %,31.2 %,and 41.7 %,respectively; while in the Gn Rh-a group were 0 %,16.3 %,and 40.0 %,respectively.There were no difference between the two groups after the 1 year and 3 years therapy（ P 〉0.05）.Besides,all of the 55 cases in the Gn Rh-a group had side-effects,but no severe adverse effect was encountered.All the side-effects were disappeared after stopping the treatment.The pregnancy rate of the patients with the EFI score of 8- 10 was respectively 31.3 % 1 year and 62.5 % 3 years after the treatment.However,the pregnancy rate of the patients with the EFI score of 5- 7 was respectively 15.2 % 1 year and 26.0 % 3 years after the treatment.There were only 9 patients with the EFI score of 0- 4,and all of them were not pregnant.The EFI score had positive correlation with the pregnancy rate 1 year and 3 years after the treatment（rs= 0.204,P= 0.039; rs= 0.437, P 〈0.001）.Conclusions The treatment of Gn Rh-a after the laparoscopic surgery can not only increase the rate of the pregnancy,but also delay the pregnancy occasion and increase the occurrence of the side-effects.The EFI may be valuable for forecasting the rate of pregnancy in patients with endometriotic infertility.The patients with EFI score higher than 8 may expect the pregnancy,while the ones with below 7 probably have much lower rate of natural pregnancy rate.