腹腔镜手术联合药物治疗卵巢子宫内膜异位囊肿相关性不孕的临床疗效

Evaluation of Combining Laparoscopic Surgery and Postoperative Medical Therapy in the Treatment of Ovarian Endometrioma Associated Infertility

目的:探讨腹腔镜手术联合药物治疗卵巢子宫内膜异位囊肿相关性不孕的临床疗效。方法:回顾性分析2009年1月至2013年1月就诊于我院妇科行腹腔镜手术的卵巢子宫内膜异位囊肿相关性不孕患者203例,根据术后用药与否分成3组:单纯手术组(A组)65例,孕三烯酮组(B组)71例,Gn RH-a组(C组)67例。所有患者随访24个月,对比各组临床完全缓解率、部分缓解率、复发率、术后自然妊娠率。结果:A组、B组、C组的完全缓解率分别为28.57%、48.57%、84.38%,B组和C组的完全缓解率均显著高于A组(P<0.01)。A组、B组、C组的复发率分别为30.16%、14.29%、10.94%,A组的复发率均显著高于B组和C组(P<0.05)。C组的自然妊娠率显著高于A组和B组(71.88%vs 30.16%,40.00%,P<0.01)。结论:腹腔镜手术联合药物治疗可提高卵巢子宫内膜异位囊肿相关性不孕患者的完全缓解率,降低术后复发率;腹腔镜手术联合Gn RH-a治疗可显著提高术后自然妊娠率。

Objective： To study the efficacy of combining laparoscopic surgery and postoperative medical therapy in the treatment of ovarian endometrioma associated infertility. Methods： From Jan.2009 to Jan.2013, 203 patients with ovarian endometrioma associated infertilitywere enrolled in this retrospective study in People ＇s Hospital of Xingning. They were grouped as follows ：65 patients（Group A, surgery only）; 71 patients in gestrinone group（Group B） and 67 patients in Gn RH-a group（Group C） All patients were followed up by 24 months and analyzed the complete clinical relief rate,the recurrence rate and natural pregnancy rate. Results：The complete clinical relief rates of group B（48.57%） and C（84.38%） were significantly higher than that of group A（28.57%, P〈0.01）. The recurrence rate of group A（30.16%） was significantly higher than that of group B（14.29%） and group C（10.94%）. The natural pregnancy rate of group C was 71.88%, significantly higher than that of group A（30.16%,P〈0.01）and gorup B（40.00%,P〈0.01）. Conclusions： Postoperative medical therapy（Gn RH-a withgestrinone） was effective in the treatment of ovarian endometrioma associated infertility, which could improve the complete clinical relief rate and decrease the recurrence rate.Laparoscopic surgery combining with postoperative Gn RH-a significantly improves the natural pregnancy rate.