子宫腺肌病合并子宫内膜异位症不孕患者术后妊娠影响因素分析

Analysis of influencing factors of postoperative pregnancy in infertility patients with adenomyosis and endometriosis

目的探讨子宫腺肌病(AM)伴子宫内膜异位症(EMT)不孕患者术后妊娠的影响因素,寻找提高术后妊娠率的方法。方法选取自2020年1月至2021年6月救治的AM伴EMT不孕患者86例,所有患者均行姑息性手术治疗,术后定期随访。以术后12个月是否受孕分为两组,21例受孕患者为妊娠组,65例未受孕患者为非妊娠组。收集患者年龄、腹部手术史、不孕类型、不孕时间、体质量指数(BMI)、AM病灶类型、EMT分型、美国生育学会的修正子宫内膜异位症分期(r-AFS)、手术时间、术中出血量、术后是否采用激素治疗和辅助生育、输卵管通畅情况、术后窦卵泡计数(AFC)、EMT生育指数(EFI)及EMT囊肿最大直径,并分析影响AM伴EMT不孕患者手术效果的因素。结果两组患者年龄、腹部手术史、不孕类型、不孕时间、AM病灶类型、r-AFS分期、EFI评分、术后AFC、EMT囊肿最大直径及术后激素治疗、术后辅助生育、输卵管通畅情况比较,差异有统计学意义(P<0.05)。多因素分析结果显示,原发性不孕(OR=2.719,95%可信区间1.152~7.483)、r-AFS分期Ⅲ~Ⅳ期(OR=1.493,95%可信区间1.129~3.228)、EFI评分<6.5分(OR=1.716,95%可信区间1.042~2.984)、术后AFC<7个(OR=2.262,95%可信区间1.928~5.338)、输卵管不通畅(OR=2.926,95%可信区间2.419~6.483)是AM伴EMT不孕患者术后不孕的危险因素(P<0.05);术后辅助生育(OR=0.556,95%可信区间0.218~0.760)是AM伴EMT不孕患者术后不孕的保护因素(P<0.05)。结论影响AM伴EMT不孕患者术后疗效的因素有r-AFS分期高、EFI评分低、术后AFC少、原发性不孕、输卵管不通畅。对于合并上述危险因素的患者可建议其采用辅助生育,可有助于提高妊娠率。

Objective To analyze the influencing factors of postoperative pregnancy in infertility patients with adenomyosis(AM)and endometriosis(EMT),and to explore the methods to improve the postoperative pregnancy rate.Methods A total of 86 infertility patients with AM and EMT who underwent palliative surgery from January 2020 to June 2021 were selected,and all the patients were regularly followed up after the surgery.The patients were divided into two groups according to whether they were pregnant or not at 12 months after surgery.Twenty-one successful pregnancy patients were in the pregnancy group,and the other sixtyfive patients who were not pregnant were in the non-pregnant group.Age,previous abdominal surgery,type of infertility,duration of infertility,body mass index(BMI),AM type,EMT stage,the revised American Fertility Society classification(r-AFS),operation time,intraoperative blood loss,adopting hormone therapy and assisted reproduction or not after surgery,unobstructed rate of fallopian tube,postoperative antral follicle count(AFC),endometriosis fertility index(EFI)and maximum diameter of EMT cyst were collected for univariate analysis,and the factors affecting the surgical outcome of infertility patients with AM and EMT were analyzed.Results There were significant differences in age,previous abdominal surgery,type of infertility,duration of infertility,AM type,r-AFS stage,EFI score,postoperative AFC,maximum diameter of EMT cyst,postoperative hormone therapy,postoperative assisted reproduction,and unobstructed rate of fallopian tube between the two groups(P<0.05).Multiplefactor analysis showed that primary infertility(OR=2.719,95%credibility interval 1.152 to 7.483),r-AFS stageⅢ-Ⅳ(OR=1.493,95%credibility interval 1.129 to 3.228),EFI score<6.5 scores(OR=1.716,95%credibility interval 1.042 to 2.984),postoperative AFC<7(OR=2.262,95%credibility interval 1.928 to 5.338),tubal obstruction(OR=2.926,95%credibility interval 2.419 to 6.483)were the risk factors for postoperative infertility in AM and EMT infertility patients(P<0.05).Postoperative assisted reproduction(OR=0.556,95%credibility interval 0.218 to 0.760)was the protective factors of postoperative infertility in AM and EMT infertility patients(P<0.05).Conclusion Influencing factors of postoperative pregnancy in infertility patients with AM and EMT include high r-AFS stage,low EFI score,less postoperative AFC,primary infertility and tubal obstruction.For patients with the above risk factors,assisted reproduction can be recommended to increase the pregnancy rate.