影响输卵管积水患者腹腔镜术后妊娠率的相关因素分析

Multivariate Analysis of Pregnancy Rate after Laparoscopic Surgery in Patients with Hydrosalpinx

目的:研究输卵管积水患者腹腔镜术后影响其自然妊娠率的高危因素,为患者个体化治疗提供临床依据。方法:回顾性分析我院2010年1月至2013年12月因输卵管积水行腹腔镜手术患者643例的临床资料,并对影响其自然妊娠率的因素进行单因素及多因素Logistic回归分析。结果:643例患者临床妊娠率为34.06%(219/643),正常宫内妊娠率为21.15%(136/643),流产率为3.89%(25/643),异位妊娠率为9.02%(58/643)。单因素分析结果显示,输卵管积水患者腹腔镜术后自然妊娠率与年龄、不孕年限、是否有盆腹腔手术史及盆腔输卵管病变程度有关(P<0.1),与不孕类型、体质量指数、是否有异位妊娠史、单侧或双侧积水、主刀医师不同无关(P>0.1);多因素分析显示,不孕年限>5年(OR=1.539,P=0.008)和盆腔输卵管中、重度病变(OR=1.569,P=0.001)是输卵管积水患者腹腔镜术后影响其妊娠能力的独立危险因素。结论:在指导输卵管积水患者腹腔镜术后适时妊娠方面,应充分考虑患者的不孕年限和输卵管病变程度,实现个体化治疗,有望提高妊娠率。

Objective：To analyze the risk factors of natural pregnancy rate after laparoscopic surgery in patients with hydrosalpinx, and to provide clinical evidence for individual treatment. Methods： 643 patients with hydrosalpinx receiving laparoscopic surgery from January 2010 to December 2013 in our hospital were enrolled into the study. The post-operative pregnancy of patients and related factors were analyzed by the single factor analysis and multivariate logistic regression analysis. Results：After 24 -36 months of foUow-up, the clinical pregnancy rate, intrauterine pregnancy rate, miscarriage rate, and ectopic pregnancy rate of 643 patients were 34.06% （219/ 643） ,21.15% （ 136/643 ）, 3. 89% （ 25/643 ） and 9.02% （ 58/643 ）, respectively. The single factor analysis showed that the pregnancy rate after laparoscopic surgery in patients with hydrosalpinx was correlated to age,duration of infertility, history of pelvic abdominal surgery and degree of pelvic tubal disease（ P 〈 0. 1 ） ,and unrelated to type of infertility, body mass index, history of ectopic pregnancy, unilateral or bilateral hydrosalpinx and difference of surgeons（ P〉0. 1）. The multivariate logistic regression analysis showed duration of infertility 〉5 years（ OR= 1. 539, P =0. 008） and moderate to severe degree of pelvic tubal disease （ OR = 1. 569, P = 0. 001 ） were independent risk factors affecting natural pregnancy rate after laparoscopic surgery in patients with hydrosalpinx. Conclusions ：We should give full consideration to the duration of infertility and degree of pelvic tubal disease in guiding timely pregnancy of patients after surgery,to realize the individual treatment and improve the pregnancy rate.