子宫内膜异位症合并不孕症患者术后自然妊娠率的影响因素分析

Natural pregnancy rate after operation and its influence factors in infertile patients with endometriosis

目的观察子宫内膜异位症(EMT)合并不孕症患者接受开腹或腹腔镜手术治疗后的妊娠情况,并分析各种因素对术后自然妊娠率的影响。方法选取2011年1月-2014年1月因不孕并且有生育要求而就诊于苏州大学附属第一医院的女性患者的临床资料,以确诊为EMT的138例患者为研究对象。统计分析患者一般临床资料及手术情况,分析术后自然妊娠率及相关影响因素。结果完成随访的138例患者中,45例患者自然妊娠,总体受孕率为32.61%,多因素Logistic回归分析提示影响EMT患者术后自然妊娠率的相关因素为:年龄、不孕类型、临床病理类型、修正子宫内膜异位症分期法(r-AFS)、术前抗穆勒氏管激素(AMH)和是否术后促性腺激素释放激素类似物(Gn RH-a)治疗,各因素间比较,差异有统计学意义(P<0.05)。结论手术可提高EMT不孕症患者的术后自然妊娠率,是治疗EMT不孕症的有效手段,并且术后6~12个月自然妊娠率最大,是妊娠的最佳时机,此后随着时间的延长,妊娠率不断下降。患者年龄、不孕类别、临床病理类型、r-AFS分期、术前AMH水平及术后是否使用Gn RH-a是影响EMT不孕症患者术后自然妊娠率的重要因素。

Objective To analyze natural pregnancy rate and its influence factors in post-operative infertile patients with endometriosis. Methods A retrospective analysis was carried out from January 2011 to January 2014 in 138 infertile patients diagnosed with endometriosis. All of them underwent surgeries in the First Affiliated Hospital of Soochow University. The patients were followed up by telephone and outpatient interview. The clinical data and operation of the patients were statistically studied, and the natural pregnancy rate and related factors were analyzed. Results Totally 45 patients gained natural pregnancy （32.61%）. Multivariate logistic regression analysis showed that influence factors of natural pregnancy rate were age, type of infertility, pathological type, r-AFS staging, preoperative AMH and whether receiving postoperative GnRH-a treatment or not （P 〈 0.05）. Conclusions Surgery can significantly improve natural pregnancy rate in infertile patients with endometriosis and it is an effective method for treatment of infertility caused by endometriosis.