腹腔镜诊断盆腔子宫内膜异位症及对不孕症患者的疗效观察

目的探讨腹腔镜诊断子宫内膜异位症(endometriosis,EMT)病灶的准确性及其与病理诊断的符合率。观察应用腹腔镜治疗EMT引起的不孕症的疗效。方法对180例EMT患者行腹腔镜下病灶切除术,记录EMT病灶在盆腔内的分布特点,并同时对肉眼观察正常的腹膜组织随机活体组织检查。对其中95例不孕症患者比较不同分期术后妊娠率及流产率。结果①180例患者腹腔镜诊断腹膜EMT与病理诊断比较,阳性预测值77.7%,敏感度为90.5%,阴性预测值为86.4%,特异度为41.2%。肉眼观察正常进行腹膜活体组织检查的162份标本中,38例(23.5%)病理检查阳性。EMT病灶在盆腔中的分布以盆腔后半部最多见。②95例不孕症患者术后66例妊娠,各期患者术后累计妊娠率比较,差异有统计学意义(P<0.05);术后24周内妊娠率77.3%(51/66),明显高于术后25周后妊娠率22.7%(15/66),差异有统计学意义(P<0.05)。66例妊娠患者中,流产6例,流产率与EMT分期无关(P>0.05)。结论①腹腔镜下所见的EMT蓝色病灶及宫骶韧带病灶的病理诊断阳性率较高,盆腔EMT病灶的分布呈非对称性,盆腔后部多于前部,左侧多于右侧;②应用腹腔镜可检查、诊断各期EMT及其引起不孕症的盆腔因素,腹腔镜手术治疗可提高EMT患者的妊娠率,且EMT手术后应尽早指导患者妊娠。

Clinical diagnosis of pelvis edometriosis and the effect on the infertility by Laparoscopy

Objective To study the coincidence of diagnosis accurate for the endometriosis(EMT) by Laparoscopy with pathologic diagnosis and to observe clinical effect of Laparoscopic treatment on the infertile women with endometriosis.Methods ①About 180 cases with EMT were under resection operation for the EMT focus and distribute characteristic of EMT focus was observed and recorded.Peritoneum issues by macroscopic observation as normal were taken biopsy randomly.②Pregnancy rate and abortion rate of 95 infertile cases under Laparoscopic treatment among 180 cases were compared according to different stages.Results ①The positive predictive value(PPV) was 77.7%,the sensitivity was 90.5%,the negative predictive value(NPV) was 86.4% and the specificity was 41.2% by Laparoscopy diagnosed for 180 cases.In addition,38 cases accounting for 23.5% was positive identified as EMT by pathological examination among 162 samples under peritoneum biopsy.The peritoneal EMT focus almost located in posterior part of the pelvis.②Among all the 95 infertile cases,66 cases became pregnant in 36 weeks after surgery while the accumulative pregnancy rates were not significantly different among different stages(P>0.05).The accumulative pregnancy rate within 24 weeks after surgery(77.3%,51/66) was higher than that within 25~36 weeks after surgery(22.7%,15/66) and the difference was significant(P>0.05).Among 66 pregnancy cases,6 cases were abortion.The abortion rate was no correlation with EMT stages(P>0.05).Conclusion ①The pathologic diagnosis rate of peritoneal blue EMT lesions or in sacral ligament are higher and the study shows unsymmetrical distribution of pelvic EMT as the lesion in the posterior and the left are more than those in the anterior part and the right.②Early lesions of endometriosis and pelvic factors for infertility can be found by Laparoscopy.And pregnancy rate in endometriosis cases can be improved by Laparoscopic surgery and the cases with EMT after Laparoscopic surgery should be guided to pregnant as soon as possible.