EFI对子宫内膜异位症宫腹腔镜术后自然妊娠的预测作用

Predictive Effect of Endometriosis Fertility Index on Natural Pregnancy After Hysteroscopic and Laparoscopic Surgery for Endometriosis

目的:探讨子宫内膜异位症生育力指数(EFI)评分系统对子宫内膜异位症(EMS)合并不孕患者术后自然妊娠率的预测价值。方法:回顾性分析2018年1月-2019年12月绍兴市妇幼保健院生殖外科76例行宫腹腔镜治疗的EMS合并不孕症患者的临床资料,分析术后2年的自然妊娠率、妊娠时间与美国生育协会修订子宫内膜异位症评分系统(r-AFS)分期和EFI评分的相关性。结果:76例患者中术后2年内妊娠56例(73.68%),其中自然妊娠45例(59.21%),自然妊娠率EFI≥9分组为70.0%,EFI 5~8分组为59.25%,EFI≤4分组为11.11%,EFI≥9分组、EFI 5~8分组与EFI≤4分组比较,差异有统计学意义(P<0.05)。ROC曲线分析得出EFI临界点为7.5分,EFI>7.5分与<7.5分的自然妊娠率比较,差异有统计学意义(P<0.05)。r-AFS分期各组自然妊娠率比较,差异无统计学意义(P>0.05)。自然妊娠率在术后第1年(51.31%)与第2年(16.22%)比较,差异有统计学意义(P<0.05)。结论:依据EFI评分指导妊娠方案能提高EMS合并不孕患者术后自然妊娠率。

Objective: To investigate the predictive value of endometriosis fertility index(EFI) scoring system for the postoperative natural pregnancy rate in patients with endometriosis(EMS) and infertility. Methods: A retrospective analysis of clinical data was performed among 76 patients with EMS and infertility who underwent hysteroscopic and laparoscopic treatments in Department of Reproductive Surgery, Shaoxing Woman and Children’ s Hospital from January 2018 to December 2019. The natural pregnancy rate and pregnancy time of patients within 2 years after operation, and the correlation with the stage by the revised American Fertility Society(AFS) scoring system and EFI score were analyzed. Results: Among the 76 patients, 56 patients had a pregnancy within 2 years after operation(73.68%) and 45 of them had natural pregnancy(59.21%). The natural pregnancy rates were 70.0%in EFI ≥ 9 points group, 59.25% in EFI 5-8 points group, and 11.11% in EFI ≤ 4 points group, respectively. The difference between EFI ≥ 9 points group, EFI 5-8 points group, and EFI ≤ 4 points group was statistically significant(P<0.05). The critical point of EFI obtained by ROC curve analysis was 7.5 points. The difference of natural pregnancy rate was statistically significant between EFI > 7.5 points and EFI < 7.5 points(P<0.05). The natural pregnancy rate showed no significant difference between rAFS stages(P>0.05). The difference of natural pregnancy rate was statistically significant between the first year(51.31%) and the second year(16.22%) after operation(P<0.05). Conclusion: Pregnancy scheme based on EFI can improve the natural pregnancy rate of EMS patients with infertility.