腹腔镜联合药物治疗中重度子宫内膜异位症合并不孕症的临床分析

目的:探讨腹腔镜联合药物治疗中重度子宫内膜异位症伴不孕的临床价值。方法:对78例Ⅲ~Ⅳ期子宫内膜异位症伴不孕症在腹腔镜下行卵巢子宫内膜异位囊肿剔除术,粘连分离术,异位病灶电凝术,输卵管造口术及输卵管通液术。术后随机分为三组,A组28例未用药物治疗,B组23例内美通治疗三月,C组27例诺雷德治疗三月。比较三组患者术后复发、妊娠结局及用药副作用情况。结果:本组患者术后均病理诊断证实为子宫内膜异位症。至随访时,A、B、C组术后妊娠率分别为17.86%、30.43%、44.44%,复发率分别为32.14%、17.39%、14.81%。B、C组比A组的妊娠率高,而复发率低(P<0.05)。B组患者的副反应以高雄激素症状为主,C组患者的副反应以低雌激素所至围绝经期征候为主,均于停药后恢复。结论:应用腹腔镜可诊断各期内膜异位症及其引起不孕症的盆腔因素;腹腔镜手术治疗可提高内膜异位症患者的妊娠率。在腹腔镜术后加用抑制卵巢功能药物对提高妊娠率、降低复发率有重要作用。

Clinical study of laparoscopic operations combined with endocrinal therapy on treatment of mild and severe endometriosis associated with infertility

Objective:To study the clinical value of laparoscopic operations combined with endocrinal therapy on the treatment of endometriosis associated with infertility,including Ⅲ and Ⅳ phases.Methods:Laparoscopic operations were completed in 78 cases of endometriosis associated with infertility.All post operative cases were divided into 3 groups,28 without endocrinal therapy(Group A),23 treated with synthesis progesterone(gestrinone)(Group B) and 27 with ganodotropin releasing hormone-analogue(GnRHa)(Group C).The recurrence,following pregnancy rate and side effects were compared.Results:In Group A,B and C,the recurrent rates were 32.14%,17.39% and 14.81%,respectively;the pregnancy rate were 17.86%、30.43%、44.44%,respectively.There was a significant difference in recurrence rates or pregnancy rates between Group A and Group B、C.The most severe side-effects of Group B was hyper-androgenndrome,and menopause syndrome in Group C.Conclusions:Laparoscopic operations can be used in the treatment of endometriosis associated with infertility.Laparoscopic operations combined with post operative endocrinal therapy have significant importance for enhancement of fecundity in infertile women with mild and severe endometroiosis.