127例重度子宫内膜异位症合并不孕保守性手术临床分析

目的:比较重度子宫内膜异位症合并不孕接受腹腔镜手术与开腹手术的疗效,评价术后辅助药物治疗的价值,探讨术后受孕的最佳时机。方法:回顾性分析59例行腹腔镜手术(腹腔镜组)和68例开腹手术(开腹组)保守性治疗的重度子宫内膜异位症合并不孕者资料,术后随访12个月比较两种手术方法的优缺点和治疗有效性。结果:手术时间、术后发热率、术后肛门排气时间、术后住院日腹腔镜组均小于开腹组,P<0.001;腹腔镜组术后恢复正常工作的时间明显早于开腹组,P<0.001;术后痛经改善情况、术后1年复发率、术后1年妊娠率两组比较均无统计学差异,P>0.05;两组术后1～6月妊娠率明显高于7～12月妊娠率,P<0.05。术后用GnRHa治疗56例的术后复发率低于未用药者,P<0.05,术后妊娠率两者比较无统计学差异,P>0.05。结论:腹腔镜手术对治疗重度子宫内膜异位症安全有效,可作为治疗重度子宫内膜异位症的首选手术方式。保守性手术可提高患者妊娠率,术后6个月内是受孕的最佳时机。对重度内异症患者术后应用GnRHa可减少复发。

Clinical analysis on conservative surgery for severe endometriosis-associated infer-tility in 127 cases

Objective:To compare the clinical effects of laparoscopy and laparotomy on severe endometriosis-associated infertility,evaluate the value of drug therapy after surgery,explore the appropriate time to regain fertility.Methods:Clinical data of 127 cases with severe endometriosis-associated infertility were analysed retrospectively and followed up 12 months after operation,including 59 cases undergoing laparoscopy(laparoscopy group) and 68 cases undergoing laparotomy(laparotomy group).The advantages and effects of laparoscopy and laparotomy were compared after 12 months.Results:Operating time,fever rate,anus gas discharge <24 hours rate after surgery,the hospital stay time and recovery time in laparoscopy group were shorter than those in laparotomy group(P<0.001);there was no significant difference in ameliorated dysmenorrhea,recurrence rate and pregnancy rate after 1 year between laparoscopy group and laparotomy group(P>0.05).Pregnancy rate during 1~6 months after surgery was higher than that during 7~12 months after surgery(P>0.05).Recurrence rate of 56 cases treated with GnRHa therapy after surgery was lower than that without GnRHa therapy(P<0.05),but there was no significant difference in regnancy rate between cases with GnRHa therapy and cases without GnRHa therapy(P>0.05).Conclusion:Laparoscopy in the treatment of severe endometriomas is currently preferred surgical procedure and can replace laparotomy.It is also safe and feasible for severe endometriosis.Conservative operation can improve pregnancy rate,patients would more likely have pregnancy within 6 months after surgery.For severe endometriosis,combined GnRHa therapy with surgery can decrease occurrence.