腹腔镜手术治疗子宫内膜异位症合并不孕患者术后后续治疗的方法探讨

目的 对腹腔镜术后子宫内膜异位症(endometriosis,EMT)合并不孕的患者进行不同分组及指导妊娠,探索提高术后妊娠率的方法.方法 应用ASRM分期对2010年1月至2011年6月在北京妇产医院妇科行腹腔镜手术的146例EMT合并不孕的患者进行前瞻性研究,对ASRM分期的各期患者制定不同的妊娠指导方案,术后随访5年,统计妊娠率、妊娠结局及复发率.结果 ①总妊娠率为89.04％,各期均获得满意妊娠率.ASRM分期与术后自然妊娠率(x2=4.069,P=0.254)、足月分娩(x2=0.605,P=0.895)及自然流产(x2=0.394,P=0.942)的比率没有显著性差异.②术后5年复发率为9.6％(14/146),78.6％的患者在术后2年内复发.结论 EMT分期与术后妊娠率无明确相关性.对EMT合并不孕的患者术后进行严格管理并制定积极的妊娠方案能显著提高此类患者的妊娠率.

Follow-up treatment of endometriosis combined with infertility after laparoscopic surgery

Objective To explore methods to improve pregnancy rates in different r-AFS after laparoscopic surgery in patients with endometriosis combined with infertility.Methods A prospective study was carried out in endometriosis combined with infertility patients who had laparoscopic surgery in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011.After operation,these patients were divided into 4 groups by r-AFS score.Using different pregnancy guidance,these patients were followed-up for 5 years.Results ①The overall pregnancy rate was 89.04％(130/146).All four groups achieved satisfying pregnancy rates and the r-AFS score had no statistics difference in post-operation natural pregnancy rates (x2=4.069,P =0.254),term labor rates (x2=0.605,P =0.895)and spontaneous abortion rates (x2=0.394,P =0.942).②Postoperative 5 years recurrence rate was 9.6％ (14/146) and 78.6％ recurrence were diagnosed within 2years after operation.Conclusion Stages based on r-AFS score level is not correlated with with postoperative pregnancy rates.Strict postoperative management and positive pregnancy scheme can significantly improve pregnancy rate of endometriosis patients with infertility.