腹腔镜下微创治疗子宫内膜异位症合并不孕症妊娠结局及影响因素

Pregnancy outcomes of infertility women with endometriosis treated by laparoscopic minimally invasive surgery and its influence factor

目的:分析腹腔镜下微创治疗子宫内膜异位症合并不孕患者妊娠结局及影响因素。方法:收集2016年1月-2019年1月本院收治的EMT合并不孕患者116例临床资料,统计妊娠结局,并以logistic回归模型分析影响妊娠结局的危险因素。结果:116例中术后妊娠76例(65.5%),其中自然妊娠59例、辅助生育妊娠17例;r-AFS分期为Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期患者妊娠率分别为64.7%、62.5%、72.0%、56.3%;EFI评分≤4分、5~8分、9~10分患者妊娠率分别为38.1%、63.0%、79.6%。76例最终活产儿49例(64.5%),异位妊娠11例(14.5%),自然流产15例(19.7%),死产1例(1.3%);r-AFS不同分期者妊娠结局未见差异(P>0.05),EFI评分高、术后予以GnRH-a治疗者妊娠结局良好者多(P<0.05)。多因素分析,年龄≥35岁、宫腔操作≥2次、术后未予以GnRH-a治疗、EFI评分低、不孕时间≥3年为EMT合并不孕患者腹腔镜下微创治疗术后妊娠不良结局的危险因素(P<0.05)。结论:腹腔镜下微创治疗对子宫内膜异位症合并不孕患者对妊娠结局改善有较理想效果;年龄、宫腔操作、GnRH-a治疗、EFI评分、不孕年限为妊娠不良结局危险因素。

Objective:To analyze the pregnancy outcome of infertility women with endometriosis treated by laparoscopic minimally invasive surgery,and to study its influence factors.Methods:The clinical data of 116 infertility women with endometriosis treated by laparoscopic minimally invasive surgery were collected from January 2016 to January 2019.The pregnancy outcomes of these women were statistics analyzed.Logistic regression model was used to analyze the risk factors affecting the pregnancy outcomes of these women.Results:Among the 116 women,there were 76 women with pregnancy after surgery,which included 59 women with natural pregnancy and 17 women with pregnancy after assisted reproductive.The pregnancy rate of the women with r-AFS stageⅠ,Ⅱ,Ⅲ,andⅣwere 64.7%,62.5%,72.0%,and 56.3%,respectively.The pregnancy rate of the women with EFI score≤4 points,5-8 points,and 9-10 points were 38.1%,63.0%,79.6%,respectively.In 76 women with pregnancy,there were 49(64.5%)women with live born infants,11(14.5%)women with ectopic pregnancy,15(19.7%)women with spontaneous abortion,and 1(1.3%)woman with stillbirth.There was no significant difference in pregnancy outcomes among the women with different stages of R-AFS(P>0.05).The rate of normal pregnancy outcomes of the women with high EFI score and postoperative GnRH-A treatment was significant higher(P>0.05).Multivariate analysis had showed that≥35 years old,≥2 times of intrauterine operation,no postoperative GnRH-a treatment,low EFI score,and duration of infertility≥3 years were the risk factors of adverse pregnancy outcomes of infertility women with EMT after laparoscopic minimally invasive surgery(P<0.05).Conclusion:Laparoscopic minimally invasive surgery for treating infertility women with endometriosis has an ideal clinical effect for improving their pregnancy outcomes.Age,the number of intrauterine operation,postoperative GnRH-a treatment,EFI score,and duration of infertility are the risk factors of their adverse pregnancy outcomes.