卵巢型子宫内膜异位症对母儿围产结局的影响

Effect of Ovarian Endometrioma on Pregnancy Outcomes

【目的】探讨卵巢型子宫内膜异位症对母儿围产结局的影响。【方法】回顾性分析2010年1月至2014年1月就诊于我院妇科行腹腔镜手术的单侧卵巢子宫内膜异位症患者162例(EM组),失访6例。对照组为同期接受腹腔镜下单侧卵巢囊肿剔除术的非子宫内膜异位症患者152例(NEM组),失访8例。其中,两组患者根据妊娠方式各分为两个亚组,即自然妊娠组(其中,EM1组92例;NEM1组112例)和经ART妊娠组(其中,EM2组64例;NEM2组32例)。追踪和随访各组患者的围产结局,并对相关观察指标进行分析和统计。【结果】EM1组的流产率、早产率均比NEM1组高,差异有统计学意义(P分别为0.01和0.04),但是小于胎龄儿的发生率两组之间差异无统计学意义(P>0.05)。EM1组的胎膜早破、前置胎盘和产后出血的发生率均高于NEM1组,差异有统计学意义(P值分别为0.01、0.03、0.02)。EM2组的胎膜早破的发生率较NEM2组明显升高,差异有统计学意义(P=0.03)。【结论】卵巢型子宫内膜异位症可增加妊娠期发生流产、早产、前置胎盘、胎膜早破的风险以及增加产后出血的风险。

[Objective] To study the effect of ovarian endometrioma on pregnancy outcomes. [Methods] From January 2010 to January 2014, the patients with unilateral ovarian cyst were enrolled in this retrospective study （EM group： 162 with ovarian endometrioma; NEM group： 152 with pathological confirmed non-endometriosis）. They all received laparoscopic excision of ovarian cyst in Ganzhou People＇s Hospital. Six cases of EM group and 8 cases of NEM group were lost during follow-up. These two groups were divided into subgroups according to their way of pregnancy： natural pregnancy group （EM 1 ： 92 cases; NEM 1 ： 112 cases） and ART group （EM2： 64 cases; NEM2： 32 cases）. Analysis was performed about the pregnancy outcomes between these groups. [Results] The miscarriage rate and preterm birth rate of EM1 group were significant higher than that of ENM1 group （P =0.01 ; P = 0.04, respectively）. But there was no difference of the rate of small for gestational age between these two groups. The risk of premature rupture of membrane, placenta previa and postpartum hemorrhage were increased in EM1 group, compared to the NEM1 group （P= 0.01; P = 0.03; P = 0.02, respectively）. The risk of premature rupture of membrane of EM2 group was also significantly higher than NEM2 group （P = 0.03）. [ Conclusions] Ovarian endometrioma increased the risk of miscarriage rate, preterm birth, premature rupture of membrane and placenta previa during pregnancy and also increased the risk of postpartum hemmorrhage.