子宫内膜异位症型不孕患者经腹腔镜治疗后生殖功能的影响因素分析

Analysis of the influencing factors of reproductive function in patients with endometriosis after laparo-scopic treatment

目的：探讨子宫内膜异位症型不孕患者经腹腔镜治疗后妊娠情况的影响因素。方法选取2009年12月至2012年12月妇产科收治的120例子宫内膜异位症型不孕症行腹腔镜手术的患者为研究对象，术后采用定期门诊复诊及电话回访相结合的方式随访2年；观察统计术后患者妊娠率，收集患者不孕类型、不孕时间、r?AFS分期、病理分型、术后使用促排卵药物，术后使用亮丙瑞林等治疗的相关临床因素，分析影响术后妊娠率的相关因素。结果120例患者术后2年共有84例患者妊娠，累计妊娠率为70?00％，其中术后1年妊娠50例，累计妊娠率为41?67％，未妊娠为36例（30?00％）。术后妊娠率而在不孕类型（原发性不孕妊娠率81?0％与继发性不孕妊娠率48?8％）、不孕时间≤3年妊娠率88?2％与＞3年妊娠率46?2％、年龄（＜35岁75?9％与≥35岁58?5％）及促排卵治疗（促排卵治疗86?0％与未治疗58?6％）方面差异均有统计学意义（ P均＜0?05）；在病理类型、r?AFS分期、术后加用GnRh?a等方面差异均无统计学意义（ P均＞0?05）。经Pearson检验进行相关性分析，不孕时间、不孕类型及年龄与妊娠率呈负相关性（ r值分别为－0?48、－0?37、－0?51，P值分别为0?035、0?015、0?012），而促排卵治疗与妊娠正常呈正相关性（ r＝0?67，P＝0?011）。结论不孕时间越长，年龄越大及继发性不孕均可影响腹腔镜术后子宫内膜异位症型不孕患者的妊娠率，而促排卵治疗可以提高妊娠率。

Objective To investigation the influencing factors of pregnancy in patients with endometrio?sis after laparoscopic treatment?Methods One hundred and twenty cases of endometriosis type infertility under?went laparoscopic surgery patients who were treated in Gynaecology and Obstetricsin Department of Jiangning Hospital of Nanjing from December 2009 to December 2012 were selected as the research objects?Patients were followed up for 2 years after the regular outpatient visits and telephone interviews combination?Statistics was ob?served in patients with pregnancy rate, infertility type, duration of infertility, R?AFS staging, pathological type, postoperative use ovulation drugs,after the use of leuprorelin treatment clinical factors and pregnancy rates of pa?tients were collected,the influence of related factors after treatment were analyzed?Results Of 120 cases pa?tients,there were 84 cases of pregnancy 2 years after treatment,the cumulative pregnancy rate was 70?00%,in?cluding 50 cases of pregnancy 1 year after treatment, the cumulative pregnancy rate was 41?67%, 36 cases (30?00%) of no pregnancy?Postoperative pregnancy rate in the pathological type(the rate of primary infertility and secondary infertility were 48?8% and 81?0%) ,infertility time( the pregnancy rate of less than 3 years,more than 3 years were 88?2% and 46?2%) ,age( the pregnancy rate of less than 35 years old,more than 35 years old were 75?9% and 58?5%) ,promote ovulation treatment( the pregnancy rate of ovulation induction therapy and no treatment were 86?0% and 58?6%) were no statistically significant differences( P<0?05)?There were no signifi?cant differences in the pathological type,r?AFS stage and postoperative GnRh?a,and the difference was not statis?tically significant( P>0?05)?The correlation was analyzed by Pearson test showed that the duration of infertility, the type of infertility and the age were negatively correlated with the pregnancy rate( r=-0?48,-0?37,-0?51,P=0?035,0?015,0?012),while the positive correlation between ovulation induction and normal pregnancy was positive(r=0?67,P=0?011)?Conclusion The longer the duration of infertility,the greater the age and sec?ondary infertility may affect the pregnancy rate of patients with endometriosis type infertility after laparoscopic op?eration?And ovulation induction therapy can improve pregnancy rate.