子宫内膜异位症伴不孕患者腹腔镜手术治疗后妊娠的影响因素分析

Influencing factors of pregnancy after laparoscopic surgery in patients with endometriosis and infertility

目的探讨子宫内膜异位症(EMT)合并不孕患者经腹腔镜手术治疗后妊娠的影响因素。方法随机纳入2012年1月至2014年4月经腹腔镜手术治疗的EMT合并不孕患者118例,开展前瞻性随访研究。对其持续随访至少3年,统计其术后3年妊娠率、内异症生育指数(EFI)及术后治疗方案,分析术后妊娠的独立影响因素。结果 118例不孕患者中115例完成至少3年随访,其中术后妊娠82例,占71.3%。妊娠者术后应用孕三烯酮、GnRH-a及术后接受中药辅助治疗者占比较高,差异有统计学意义(P<0.05)。西药辅助是术后3年妊娠的独立保护因素(OR=6.207,P=0.001)。EFI对术后3年妊娠预测效果较差,ROC曲线下面积0.548(P>0.05)。结论西药辅助治疗可提高子宫内膜异位症伴不孕患者腹腔镜术后3年妊娠率,且其妊娠率不受EFI及是否接受辅助生殖技术的影响。

Objective To investigate the influencing factors of pregnancy after laparoscopic surgery in patients with endometriosis（ EMT） and infertility. Methods A total of 118 patients with EMT combined with infertility received laparoscopic surgery from January 2012 to April 2014 were randomly selected and prospectively followed up. All patients were followed up for at least 3 years,and the pregnancy rate within 3 years after surgery,the EMT fertility index（ EFI） and postoperative treatment method were observed,and the independent influencing factors of pregnancy rate were analyzed. Results Among the118 patients,115 cases were followed up for at least 3 years,among which 82 cases were pregnant after operation,which accounting for 71. 3%. The proportion of pregnant women who received gestational three ketene,GnRH-a and postoperative adjuvant treatment of Chinese medicine was higher,and the difference was significant（ P〈0. 05）. Western medicine adjuvant was the independent protective factor of pregnancy in 3 years after operation（ OR = 6. 207,P = 0. 001）. EFI had a poor predictive effect on pregnancy within 3 years,and the area under the ROC curve was 0. 548（ P〉0. 05）. Conclusions Drug assisted therapy can increase the 3-year pregnancy rate of endometriosis associated infertile patients after laparoscopy,and the pregnancy rate is not affected by EFI and whether or not it accepts assisted reproductive technology.