盆腔子宫内膜异位症合并不孕患者术后妊娠相关因素分析

Analysis of Postoperative Pregnancy Related Factors in Patients with Endometriosis Complicated with Infertility

目的:通过对盆腔子宫内膜异位症(EMs)合并不孕患者行宫腹腔镜联合手术治疗前后多个因素分析,探讨可能影响其术后妊娠的主要因素,为临床治疗提供科学依据。方法:收集247例EMs合并不孕且进行宫腹腔镜联合手术患者的相关资料,采用χ2检验、t检验、秩和检验、多因素Logistic回归等方法进行分析。结果:术后患者自然试孕157例,直接进入体外受精(IVF)助孕周期90例。最终未妊娠者105例,成功妊娠者142例。术后成功妊娠者和未妊娠者不孕年限、子宫内膜异位症分期(r-AFS分期)、子宫内膜异位症生育指数(EFI)评分比较,差异有统计学意义(均P<0.05),而不孕类型、是否合并子宫内膜息肉(EP)和卵巢EMs异位囊肿病灶单双侧比较,差异无统计学意义(P>0.05)。术后随着时间延长,自然妊娠率和IVF助孕妊娠率逐渐下降,趋势χ2检验差异有统计学意义(均P<0.05)。r-AFS分期、EFI评分与术后妊娠情况密切相关(P<0.05),EFI评分高为术后妊娠的保护性因素,而r-AFS分期高为术后妊娠的危险性因素。结论:r-AFS分期、EFI评分和不孕年限是子宫内膜异位症患者术后妊娠的重要影响因素,对此类患者可通过腹腔镜手术探查及治疗,尽早根据相应指标评估病情,积极采取措施指导受孕,可显著提高术后妊娠率。

Objective：To analyze retrospectively the multiple factors related to pregnancy before and after the laparoscopic surgery combined with hysteroscopy in those patients with pelvic endometriosis complicated with infertility. It is helpful for clinical treatment of this kind of diseases to explore those main factors related to the postoperative pregnancy. Methods：Clinical data of 247 patients with pelvic endometriosis complicated with infertility, and treated with hysteroscopy combined with laparoscopy, were collected. χ^2 test, t test, rank sum test and multi factor Logistic regression were used for analysis. Results：After the operation, 157 cases tried to conduct natural pregnancy, and 90 cases were directly enrolled in the IVF treatment cycle. Finally, 105 cases were not pregnant, and 142 cases had successful pregnancy. There were significant differences in the infertility years, the endometriosis stages （the r-AFS stage）, and the fertility index （the EFI score） between women with successful pregnancies and those women without pregnancy after the operation （P〈0.05）. However, there were no significant differences in the type of infertility, the incidence of endometrial polyp and the bilateral lesions of ovaries （P〉0.05）. The rate of spontaneous pregnancy and IVF-assisted pregnancy was decreased gradually with the postoperative time （P〈0.05）. The r-AFS stage and the EFI score were closely related to postoperative pregnancy （P〈0.05）, the high EFI score was the protective factor while the high r-AFS stage was the risk factor of postoperative pregnancy. Conclusions：The r-AFS stage, the EFI score and the infertility years are important factors affecting postoperative pregnancy in those patients with endometriosis after laparoscopic treatment. The rate of postoperative pregnancy can be significantly improved by the active direction of natural pregnancy and active IVF treatment according to the evaluation index of disease, as earlier as possible.