宫腔镜联合腹腔镜在子宫内膜异位症伴不孕中的治疗效果及对妊娠结局的影响

Therapeutic effect of hysteroscopic surgery combined with laparoscopic surgery on infertility caused by endometriosis and its influence on pregnancy outcomes

目的探讨宫腔镜联合腹腔镜在子宫内膜异位症(简称内异症)伴不孕中的治疗效果及对妊娠结局的影响。方法选取2017年11月至2020年10月于常州市妇幼保健院就诊的80例内异症伴不孕患者作为研究对象,按照随机数字表法分为观察组与对照组,每组40例。对照组给予腹腔镜手术,观察组给予宫腔镜联合腹腔镜治疗。比较两组临床疗效、卵巢储备功能指标、术后6个月妊娠率及不良妊娠结局。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组卵泡刺激素(FSH)、雌二醇(E2)水平比较差异无统计学意义;术后1个月,两组FSH、E2水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。术后6个月,观察组妊娠率高于对照组,差异有统计学意义(P<0.05);两组不良妊娠结局比较差异无统计学意义。结论宫腔镜联合腹腔镜应用于内异症伴不孕临床疗效显著,对卵巢储备功能及不良妊娠结局影响较小,可有效提高妊娠率,值得临床推广应用。

Objective To investigate the therapeutic effect of hysteroscopic surgery combined with laparoscopic surgery on infertility caused by endometriosis and its influence on pregnancy outcomes.Methods 80 patients with endometriosis-related infertility treated in Women's and Children's Hospital of Changzhou from November 2017 to October 2020 were selected as the research subjects,and they were randomly divided into the observation group and the control group,with 40 cases in each group.The control group underwent laparoscopic surgery,while the observation group underwent hysteroscopic surgery combined with laparoscopic surgery.The clinical efficacy,ovarian reserve function index,pregnancy rate at 6 months after operation and adverse pregnancy outcome were compared between the two groups.Results The total effective rate in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).Before surgery,there were no statistically sig-nificant differences in follicle stimulating hormone(FSH)and estradiol(E2)between the two groups;after surgery 1 month,FSH and E2 levels of the two groups were lower than before treatment,and the observation group was lower than that in the control group,the differences were statistical-ly significant(P<0.05).After surgery 1 month,the pregnancy rate in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05);there was no statistically significant difference in adverse pregnancy outcomes between the two groups.Conclusion Hysteroscopy combined with laparoscopy has significant clinical effect on endometriosis with infertility,and has little effect on ovarian reserve function and adverse pregnancy outcomes,it can effectively improve the pregnancy rate and is worthy of clinical promotion and application.