腹腔镜下治疗不孕症合并子宫内膜异位症的妊娠结局及相关因素分析

Analysis on pregnancy outcomes and related factors of infertility complicated with endometriosis treated under laparoscope

目的分析不孕症合并子宫内膜异位症腹腔镜下治疗的妊娠结局及相关影响因素。方法选择2010年12月-2013年6月于该院行腹腔镜下手术治疗的不孕症合并子宫内膜异位症患者共计148例,观察统计患者术后妊娠情况以及妊娠结局,分析术后妊娠率与术后时间、年龄、不孕时间、不孕类型、r-AFS分期、病理分型、术后使用促性腺激素释放激素激动剂(GnRH-a)及术后使用促排卵药物治疗情况等临床因素的相关性以及r-AFS分期和术后使用GnRH-a治疗与妊娠结局的相关性。结果术后3年累积妊娠85例,妊娠率为57.4%,术后<1年的总妊娠率明显高于术后1年~和2~3年的总妊娠率,差异有统计学意义(χ~2=3.697、4.358,P<0.65),术后1年~的总妊娠率明显高于术后2~3年的总妊娠率,差异有统计学意义(χ~2=4.072,P<0.05);术后妊娠率在年龄(<35岁、≥35岁)、不孕时间(≤3年、>3年)、不孕类型(原发不孕、继发不孕)、术后使用促排卵药物治疗(是、否)等临床因素中比较差异有统计学意义(χ~2=3.816、2.935、2.963、2.679,P<0.05);术后妊娠率与r-AFS分期、病理分型、术后是否使用GnRH-a治疗无关,差异无统计学意义(χ~2=1.304、0.898、1.137,P>0.05);r-AFS分期与妊娠结局(良好结局、不良结局)无关,差异无统计学意义(χ~2=1.014,P>0.05);术后是否使用GnRH-a治疗与妊娠结局有显著相关性,差异有统计学意义(χ~2=3.856,P<0.05)。结论患者年龄、不孕时间、不孕类型、是否使用促排卵药物是影响不孕症合并子宫内膜异位症患者术后妊振率的相关因素;术后是否使用GnRH-a治疗是影响妊娠结局的相关因素。

Objective To analyze the pregnancy outcomes and related influencing factors of infertile women complicated with endometriosis treated under laparoscope. Methods A total of 148 infertile patients complicated with endometriosis treated under laparoscope in the hospital from December 2010 to June 2013 were selected as observation objects. All patients＇ pregnancy situations and outcomes were observed. The relationships between postoperative pregnancy rate and postoperative time,age,duration of infertility,types of infertility,r-AFS stage,pathological types,postoperative use of gonadotropin releasing hormone agonist（ GnRH-a） and ovulation stimulants,and the relationships between r-AFS stage,postoperative use of GnRH-a and pregnancy outcomes were analyzed respectively. Results The cumulative pregnancy rate within three years after treatment was 57. 4%（ 85 cases）. The total pregnancy rate within one year after treatment was statistically significantly higher than those within 1-3 years after treatment（ χ^2= 3. 697,4. 358,P〈0. 65）. The total pregnancy rate during 1-years after treatment was statistically significantly higher than that during 2-3 years after treatment（ χ^2= 4. 072,P〈0. 05）. There were statistically significant differences in postoperative pregnancy rate among the patients with different clinical factors,such as age（ 35 years old,≥35 years old）,duration of infertility（ ≤3 years,3 years）,types of infertility（ primary infertility,secondary infertility）,postoperative use of GnRH-a（ χ^2= 3. 816,2. 935,2. 963,2. 679,P〈0. 05）. There was no correlation between postoperative pregnancy rate,r-AFS stage,pathological types,postoperative use of GnRH-a,and there was no statistically significant difference（ χ^2= 1. 304,0. 898,1. 137,P〈0. 05）. There was no correlation between r-AFS stage and pregnancy outcomes（ χ^2= 1. 014,P〈0. 05）. There was significant correlation between postoperative use of GnRH-a and pregnancy outcomes（ χ^2= 3. 856,P〈0. 05）. Conclusion Age,duration of infertility,infertility types,using ovulation induction drugs or not are the related influencing factors of pregnancy rate among patients with infertility complicated with endometriosis after surgery; postoperative therapy by taking GnRH-a is a related factor affecting pregnancy outcomes.