卵巢子宫内膜异位症患者术后自然妊娠情况及影响因素

Natural Pregnancy and Its Influencing Factors in Patients With Ovarian Endometriosis

目的探讨卵巢子宫内膜异位症(EMT)患者术后自然妊娠情况及影响因素。方法选取68例卵巢EMT患者作为研究对象,所有患者均行手术治疗,术后连续随访6个月,将自然妊娠的患者纳入妊娠组,未妊娠患者纳入未妊娠组,比较两组年龄、体重指数(BMI)、病变位置、囊肿直径、是否接受促性腺激素释放激素激动剂(GnRH-a)治疗、美国生殖医学协会EMT(r-AFS)分期、EMT生育力(EFI)评分。结果纳入的68例患者中,术后自然妊娠50例,未妊娠18例。经单因素分析显示,卵巢EMT患者术后自然妊娠情况与BMI、病变位置无关(P>0.05);可能与年龄、囊肿直径、r-AFS分期、EFI评分有关(P<0.05)。经Logistic回归分析显示,高龄、囊肿直径≥3cm、r-AFS分期≥Ⅲ期、EFI评分<7分是导致卵巢EMT患者术后未妊娠的危险因素(OR>1,P<0.05),GnRH-a治疗是卵巢EMT患者术后自然妊娠的保护因素(OR>1,P<0.05)。结论卵巢EMT患者术后自然妊娠率受多种因素影响,高龄、囊肿直径≥3cm、r-AFS分期≥Ⅲ期、EFI评分<7分是导致患者术后未妊娠的危险因素,GnRH-a治疗是患者术后自然妊娠的保护因素。

Objective To investigate the natural pregnancy and its influencing factors in patients with ovarian endometriosis(EMT).Methods 68 cases of ovarian EMT patients were selected as the research objects.All patients were treated with surgery.The patients with natural pregnancy were included in the pregnancy group,and the non pregnant patients were included in the non pregnancy group.The age,body mass index(BMI),lesion location,cyst diameter and whether to accept gonadotropin stimulation were compared between the two groups GnRH-a treatment,American Society of reproductive medicine EMT(R-AFS)stage,EMT fertility(EFI)score.Results Among the 68 patients,50 cases were naturally pregnant and 18 cases were not pregnant.Univariate analysis showed that the natural pregnancy of patients with ovarian EMT was not related to BMI and lesion location(P>0.05),but might be related to age,cyst diameter,R-AFS stage and EFI score(P<0.05).Logistic regression analysis showed that older age,cyst diameter≥3 cm,R-AFS stage ≥ stage Ⅲ,EFI score<7 were risk factors for non pregnancy in patients with ovarian EMT(or>1,P<0.05).GnRH-a treatment was a protective factor for spontaneous pregnancy in patients with ovarian EMT(or>1,P<0.05).Conclusion The natural pregnancy rate of patients with ovarian EMT is affected by many factors.The risk factors of non pregnancy are old age,cyst diameter ≥ 3 cm,R-AFS stage≥stage Ⅲ,EFI score<7.GnRH-a treatment is the protective factor of spontaneous pregnancy.