腹腔镜下子宫内膜异位症生育指数在子宫内膜异位症合并不孕中的应用研究

Application research of laparoscopic endometriosis fertility index in endometriosis complicated with infertility

目的:探讨腹腔镜下子宫内膜异位症生育指数(endometriosis fertility index,EFI)在子宫内膜异位症(endometriosis,EMT)合并不孕中的作用。方法:选取2013年4月至2017年3月400例行腹腔镜手术的子宫内膜异位症合并不孕患者的病案资料,结合病史因素、手术因素进行EFI评分,分析术后3年累积妊娠率与EFI评分、促排卵治疗史、美国生育学会修订的内异位症分期(r-AFS)、促性腺激素释放激素激动剂(GnRH-a)治疗史的相关性,比较不同临床类型EMT、术后不同时期妊娠率。结果:术后随访3年,累计妊娠185例,3年累积妊娠率为46.25%,且与EFI评分、促排卵治疗史呈现正相关(tau-b EFI评分=0.382、P=0.000,tau-b促排卵治疗史=0.453,P=0.000),与r-AFS分期、GnRH-a治疗史无相关性(P>0.05),1~12个月、13~24个月、25~36个月妊娠率分别为28.75%、14.00%、3.50%(χ2=98.710,P=0.000),各临床类型EMT患者妊娠率差异无统计学意义(P>0.05)。结论:腹腔镜下子宫内膜异位症生育指数可预测患者术后妊娠情况,指导何时采取辅助生殖技术,制订具体的诊疗方案,不建议长时间等待妊娠结局,同时EFI评分系统尚需进一步完善。

Objective:To investigate the role of laparoscopic endometriosis fertility index(EFI)in endometriosis(EMT)combined with infertility.Methods:The medical record data of 400 patients with endometriosis and infertility who underwent laparoscopic surgery from April 2013 to March 2017 were selected,combined with medical history factors and surgical factors to perform EFI score,and analyze cumulative pregnancy 3 years after surgery Correlation between EFI score,ovulation induction treatment history,American Fertility Society's revised endometriosis staging(r-AFS),gonadotropin releasing hormone(GnRH-a)treatment history,compare different clinical types of EMT,postoperative differences Period pregnancy rate.Results:After 3 years of follow-up,there were 185 cases of cumulative pregnancy.The 3-year cumulative pregnancy rate was 46.25%,which was positively correlated with the EFI score and the history of ovulation induction therapy(tau-b EFI score=0.382,P=0.000,tau-b Ovulation treatment history=0.453,P=0.000),no correlation with r-AFS staging,GnRH-a treatment history(P>0.05),pregnancy rate of 1-12 months,13-24 months,25-36 months They were 28.75%,14.00%,3.50%(χ2=98.710,P=0.000),and there was no statistically significant difference in pregnancy rates among EMT patients of various clinical types(P>0.05).Conclusion:Laparoscopic endometriosis fertility index can predict the postoperative pregnancy of patients,guide when to adopt assisted reproductive technology,formulate specific diagnosis and treatment plans,it is not recommended to wait for a long time for pregnancy outcome,and the EFI scoring system needs further perfect.