宫-腹腔镜联合治疗子宫内膜异位症合并不孕患者术后妊娠的影响因素分析

Analysis of influencing factors of postoperative pregnancy in patients with endometriosis complicated with infertility treated by combination of hysteroscopy and laparoscopy

目的分析宫-腹腔镜联合治疗子宫内膜异位症合并不孕患者术后妊娠的影响因素。方法选取2015年8月-2017年8月宁波市妇女儿童医院收治的子宫内膜异位症不孕患者80例为研究对象,均采取宫-腹腔镜联合治疗,持续随访24个月,记录患者术后妊娠率,整理患者社会性资料(年龄、BMI),疾病资料(不孕类型、不孕年限、盆腔手术史),手术及治疗情况(子宫内膜异位症病理类型、r-AFS分期、促排卵用药、术后辅助用药),采取多因素Logistic回归分析子宫内膜异位症不孕患者术后妊娠的相关影响因素。结果45例(56.25%)患者成功妊娠,其中术后6个月内妊娠31例(38.75%),术后7~12个月成功妊娠12例(15.00%),术后13~24个月成功妊娠2例(2.50%)。年龄≥35岁、原发性不孕、不孕年限≥3年、rAFS分期(Ⅲ期、Ⅳ期)是子宫内膜异位症合并不孕患者宫-腹腔镜术后妊娠的高危因素(P<0.05);术后辅助用药及促排卵用药是患者术后妊娠的保护因素(P<0.05)。r-AFS分期与术后妊娠率呈负相关关系,而促排卵用药、术后辅助用药与术后妊娠率呈正相关关系(P<0.05)。结论年龄≥35岁、原发性不孕、不孕年限≥3年、r-AFSⅢ期与r-AFSⅣ期是子宫内膜异位症合并不孕患者妊娠的高危因素,建议患者尽早及时开展宫-腹腔镜手术治疗,术后给予辅助用药、促排卵用药,加强术后管理,提升妊娠成功率。

Objective To explore the influencing factors of postoperative pregnancy in patients with endometriosis complicated with infertility by combined hysteroscopy and laparoscopy.Methods A data of 80 infertile patients with endometriosis admitted to Ningbo Women’s and Children’s Hospital from August 2015 to August 2017 were selected as research objects,all patients were treated with hysteroscopic-laparoscopy,followed up for 24 months,and the postoperative pregnancy rate was recorded.Social data of the patients(age,BMI),disease data(infertility type,infertility years,pelvic surgery history),operation and treatment status(endometriosis pathological type,rAFS stage,ovulation induction medication,postoperative adjuvant medication),multivariate Logistic regression was used to analyze the factors affecting postoperative pregnancy in infertile patients with endometriosis.Results There were 45 cases(56.25%)patients,successful pregnancy after 6 months of pregnancy,31 cases(38.75%),7~12 months after successful pregnancy 12 cases(15.00%),13~24 months after successful pregnancy in 2 cases(2.50%).Age≥35 years,primary infertility,infertility years≥3 years,r-AFS stage(Ⅲ,Ⅳ)is infertility endometriosis merger is palace-laparoscopic postoperative pregnancy risk factors(P<0.05);postoperative adjuvant medication and ovulation induction medication were protective factors for postoperative pregnancy(P<0.05).r-AFS staging was negatively correlated with postoperative pregnancy rate,while ovulation induction medication and postoperative adjuvant medication were positively correlated with postoperative pregnancy rate(P<0.05).Conclusion Age≥35 years,primary infertility,infertility years≥3 years,r-AFSⅢand rAFSⅣare the high risk factors of endometriosis complicated with infertility.It is suggested that patients should promptly carry out uterine laparoscopic surgery as soon as possible,give adjuvant drugs and drugs to stimulate ovulation,strengthen postoperative management and improve the success rate of pregnancy.