不孕症合并子宫内膜异位症患者的腹腔镜特点及其与临床表现的关系研究

Laparoscopic feature and its relationship with clinical manifestations in infertile women with endometriosis

目的探讨不孕症合并子宫内膜异位症(EM)患者的腹腔镜特点并分析其与临床表现的关系。方法回顾性分析2013年1月至2017年1月因不孕症于我院妇科行宫腹腔镜联合手术的患者204例,对其中同时合并EM的患者的腹腔镜下特点及其与临床表现的关系进行分析。结果在204例接受手术的不孕症患者中,有120例(58.8%)患者同时合并子宫内膜异位症。在不孕症合并子宫内膜异位症的患者中,其痛经、性交痛、经期肛门坠胀感、慢性盆腔痛、月经过多、附件包块、子宫活动度降低、附件压痛、阴道后穹窿触痛结节等症状和体征均与患者的r AFS分期相关;术前彩超检查亦与r AFS分期相关。随着r AFS分期的提高,病灶累及骶韧带、直肠阴道隔、阴道、肠道等盆腔其他器官和组织的几率升高。结论对于不孕症的患者,详细的病史采集、全面的双合诊检查以及经阴道彩超,有助于及时发现子宫内膜异位症,为患者个体化治疗方案的选择提供依据。

Objective To investigate the laparoscopic feature and its relationship with clinical manifestations in infertile patients with endometriosis. Methods From Jan.2013 to Jan.2017, infertile patients who received hysteroscopy and hysteroscopy combination surgery in Ganzhou People＇s Hospital were enrolled in this retrospective study. The basic clinical data and the distribution of endometriotic lesions were recorded and analyzed in patients with endometriosis simultaneously. Analysis was performed about the clinical manifestations and the rAFS stage of the patients. Results 204 patients are totally enrolled in the study. Among them, 120 patients （58.8%） had endometriosis. The presence of menorrhea, dyspareunia, tenesmus, chronic pelvic pain, hypermenonhea, adnexal mass, restricted uterine mobility, tenderness of adnexa, and tenderness nodules of posterior vaginal fornix are clinically statistically significant. In addition, the presence of ovarian endometrioma is also a significant clinical factor that is close related with the rAFS stage of infertile patients with endometriosis. Moreover, uterosacral ligament, rectovaginal septum, vagina and bowel were more common infiltrated in stage m and stage IV endometriosis. Conclusions For infertile patients, detailed case history, overall bimanual examination and traMs-vaginal ultrasound examination are very important to help diagnosis endometriosis preoperatively and provide evidence for the selection of individualized treatment strategies.