腹腔镜联合药物治疗轻度子宫内膜异位合并不孕的临床分析

目的:探讨腹腔镜联合药物治疗轻度子宫内膜异位症(EMs)伴不孕的临床价值。方法:对腹腔镜诊断的轻度EMs伴不孕症者112例,于腹腔镜下行病灶电凝烧灼、囊肿剥除,病灶周围粘连松解术和输卵管通液术等,术后随机分为两组:A组62例采用孕三烯酮治疗6个月;B组50例术后不加药物治疗,统计两组术后妊娠率及复发率并行统计学分析。结果:A、B两组治疗后各阶段的妊娠构成情况相似。总妊娠率分别为54.84%、62.00%,差异无统计学意义(P>0.05)。两组在术后0~3、4~6、7~12、13~24个月的妊娠率比较,差异无统计学意义(P>0.05)。A、B两组0~6个月妊娠率(38.71%,46.00%)均高于7~12个月的妊娠率(15.79%,18.52%),0~12个月妊娠率(48.39%、56.00%)高于13~24月的妊娠率(12.5%,13.64%),差异均有统计学意义(P<0.05)。A、B两组术后复发率分别为12.90%,42.00%,差异有统计学意义(P<0.05)。结论:腹腔镜联合药物治疗轻度EMs较单纯腹腔镜治疗并不增加术后妊娠率;腹腔镜联合药物治疗可以显著降低术后的复发率;腹腔镜术后半年或术后药物治疗停药后半年妊娠率最高,提示EMs患者应在术后或术后药物治疗停药后半年内争取妊娠,1年后未妊娠宜采用辅助生育技术助孕。

Clinical Study on the Combinative Treatment of Laparoscopic Operation and Pharmacotherapy for Mild Endometriosis Complicated with Infertility

Objective: To study the clinical value of the combinative treatment of laparoscopic operation and pharmacotherapy for mild endometriosis(EMs) complicated with infertility.Methods: Laparoscopic operations(electriccoagulation and cauterization of lesions,cystectomy,lysis of surrounding adhesion,and hydrotubation) were completed in 112 cases of mild EMs with infertility,and all cases were randomly divided into two groups after operations.62 cases were treated with gestrinone for 6 months(group A),and 50 cases weren't administered with pharmacotherapy(group B).The following pregnancy rate and recurrence rate were compared between the two groups.Results: The following pregnancy rates of group A and B were 54.84% and 62.00%,with no significant difference between the two groups(P>0.05).The pregnancy rates of 0-3,4-6,7-12,13-24 months were compared between the two groups.The pregnancy rates of 0-6 months in the group A and B(38.71%,46.00%) were higher than the 7-12 months(15.79%,18.52%),and the pregnancy rates of 0-12 months(48.39%,56.00%) were higher than the 13-24 months(12.5%,13.64%),with significant difference between the two groups(P<0.05).The recurrence rates of group A and B were 12.90% and 42.00%,and the difference was statistically significant(P<0.05).Conclusion: Compared with the simple laparoscopic treatment,the combinative treatment of laparoscopic operation and pharmacotherapy for mild EMs do not significantly improve the following pregnancy rate,but it can markedly decrease the recurrence rate.The pregnancy rate is highest in half a year after laparoscopic operation or drug withdrawal.The study shows that the patients with EMs should get pregnancy in half a year after laparoscopic operation or drug withdrawal,and assisted reproductive technology should be adopted for the non-pregnancy 1 year later.