生育指数对子宫内膜异位症相关性不孕症术后妊娠率的预测及临床价值

Clinical value of endometriosis fertility index used to predict pregrancy rate and guide the treatment of patients with endometriosis-associated infertility following the surgery

目的探讨生育指数(EFI)对预测子宫内膜异位症相关性不孕症(EAI)患者腹腔镜治疗术后妊娠率(PR)及指导术后管理的价值。方法回顾性分析2011年1月-2016年12月于南方医科大学珠江医院妇产科因子宫内膜异位症(EMT)合并不孕症行腹腔镜手术的322例患者的资料,根据EFI分数分组,根据术后是否联合使用促性腺激素释放激素激动剂(Gn RHa)分为联合治疗组和单纯手术组,根据患者术后是否行人工辅助生殖(ART)分为自然妊娠组和ART组,统计各组患者距离治疗结束后6、12、24、36个月的累积妊娠率。结果 EFI评分越高,累积妊娠率也越高。EFI指数为5-8分的小组,联合治疗组累积自然妊娠率较单纯手术组明显增高。单纯治疗组和联合治疗组的患者,皆为距离治疗结束后6个月内妊娠率增加最快;联合Gn RHa治疗,可增加5-8分组期待年限。结论 EFI指数能较好地预测EAI患者术后的妊娠率,建议EFI为5-8分的患者术后联合使用Gn RHa,并可依情况适当的延长期待时间。

Objective To investigate the value of endometriosis fertility index （EFI） in predicting the pregnancy rate （PR） of patients with endometriosis-associated infertility （EAI） after laparoscopic conservative treatment, and provide some guidance for postoperative management. Methods The clinical data were retrospectively analyzed of patients undergoing laparoscopic surgery for infertility due to endometriosis （EMT） in the Department of Obstetrics and Gynecology of Zhujiang Hospital of Southern Medical University from Jan. 2011 to Dec. 2016. The patients were divided into combined group and operation group according to whether or not they combined use of GnRHa postoperatively, natural pregnancy group and ART group according to whether or not the patients turn to artificial assisted reproduction （ART）. The accumulative PR of each group was added up 6, 12, 24 and 36 months after treatment. Results The higher the EFI score, the higher the accumulative PR. For the patients with the EFI as 5-8, the PR was significantly higher in combined group than in operation group. all the patients in operation group and combined group showed the fastest increase of pregnancy within 6 months after the end of treatment. Combined with GnRHa treatment increased the expectation of EFI 5-8 group. Conclusions EFI shows a good prediction value for the natural PR of EAI patients after surgery and for the patients with EFI score as 5-8. It is recommended for the patients with EFI score as 5-8 to use GnRHa in combination after surgery, and appropriately lengthening the expectant time according to the circumstances.