子宫内膜异位症生育指数(EFI)对EMs相关不孕妇女腹腔镜术后自然妊娠的预测价值

目的:探讨子宫内膜异位症生育指数(EFI)对EMs相关不孕患者腹腔镜术后自然妊娠率的预测价值。方法:回顾分析2008年1月至2012年3月于我院行腹腔镜治疗的730例EMs相关不孕患者,根据手术发现进行EFI评分,并随访其妊娠情况和妊娠结局。比较不同EFI分值患者的自然妊娠率,Kaplan-Meier生存分析法计算累积妊娠率,采用Log-rank检验进行比较。结果:完成随访的548例患者的总妊娠率为43.43%(238/548)。EFI评分8~10分者的总妊娠率为54.55%(168/308),8、9、10分的妊娠率分别为53.66%(66/123)、51.75%(74/143)和66.67%(28/42),各分值间比较差异无统计学意义(P=0.225)。EFI 7分者的妊娠率为42.27%(41/97),低于8~10分者,差异有统计学意义(P=0.035);EFI 4~6分的妊娠率为21.71%(28/129),4、5、6分的妊娠率分别为17.86%、19.05%和25.42%,各分值间比较差异无统计学意义(P=0.638),显著低于7分者(P=0.000)。EFI 0~3分的妊娠率为7.14%(1/14)。术后不同时间的妊娠率有统计学差异(P=0.000)。r-AFS分期I~IV期的妊娠率分别为45.23%(57/126)、47.33%(71/150)、44.08%(67/152)和44.17%(53/120),无统计学差异(P=0.939)。结论:EFI能较好地预测接受腹腔镜手术的EMs相关不孕患者的术后生育力。

Predictive value of endometriosis fertility index for pregnant rate after laparoscopy in EMs-associated infertile patients

Objective: To confirm the predictive value of endometriosis fertility index( EFI) for women with endometriosis-associated infertility.Methods: 730 infertile patients with endometriosis who underwent laparoscopy from Jan. 2008 to March 2012 were analyzed retrospectively.EFI score was recorded according to medical history and intra-operative findings.The pregnancy outcome after surgery was followed-up.Comparisons of different score with cumulative pregnancy rate( PR) were performed by χ2-test. The survival curves were got by Kaplan-Meier method and validated by Log-rank test.Results: The total PR was 43.43% among remaining 548patients( 238 / 548). The aggregated PR was 54. 55% among EFI 8 ~ 10 patients( 168 / 308),and there were no significant difference among different EFI score( 53.66%,51.75%,66.67%;P = 0.225).The PR was 42.27%( 41 / 97) in EFI score 7,which lower than those with EFI 8 ~10( P = 0.035),but higher than that of EFI 4 ~ 6( 21.71%,28 / 129; P = 0.035).There were no significant difference of cumulative PR among EFI 4,5 and 6( 17.86%,19.05%,25.42%; P =0.638).In total of 14 EFI 0 ~ 3 women,only one pregnant was completed.Kaplan-Meier survival analysis about PR in different time among EFI 8 ~ 10,7,4 ~ 6,0 ~ 3 was statistic significance( P= 0.000).However,the PR in r-AFS staging( I ~ IV) was no significant difference( 45.23%,47.33%,44. 08%,44. 17%,P = 0. 939). Conclusion: Compared with other staging system,EFI can better predict women's fecundity in endometriosis-associated infertile women with treatment of laparoscopy.