子宫内膜异位症伴不孕几种治疗方法疗效的比较

目的 :比较子宫内膜异位症伴不孕不同治疗方法的疗效。方法 :197例患者中Ⅰ期 85例 (4 3.1% ) ,Ⅱ期 6 5例 (33.0 % ) ,Ⅲ期 2 8例 (14 .2 % ) ,Ⅳ期 19例 (9.6 % )。将Ⅰ、Ⅱ期患者分为 7组 ,分别采用三苯氧胺、米非司酮、丹那唑、诺雷德、10 0℃以下异位病灶热破、安慰剂治疗 (每组 2 1± 1例 ) ;下余 1组与Ⅲ、Ⅳ期患者采用两阶段复合治疗 ,即先破坏子宫内膜异位病灶 ,切除卵巢囊肿 ,分离粘连 ;再用丹那唑治疗 6个月。观察 1年并进行比较。结果 :Ⅰ、Ⅱ期患者用三苯氧胺、米非司酮、丹那唑、诺雷德、热破、两阶段复合治疗、安慰剂治疗 ,其受孕率分别为 34%、38%、5 4%、5 2 %、4 2 %、5 2 .6 %、8.1% ;Ⅲ、Ⅳ期患者治疗后的受孕率分别为 4 5 .6 %、4 8.7%。妊娠率动态分析显示最易受孕的时间是在治疗完成后的 6～ 8个月。结论 :子宫内膜异位伴不孕症不论其病情发展程度 ,都须积极治疗。最佳的治疗方法是用促性腺制剂及两阶段复合治疗。治疗后的最佳观察期限为12个月

Clinical treatment outcome comparison of different therapeutic regime in infertility women with endometriosis

Objective:To compare the effect and value of different therapeutic regime in infertility women with endometriosis.Methods:Among the 197 patients,85(43.1%)cases were in phase Ⅰ, 65(33.0%)cases were in phase Ⅱ, 28(14.2%)cases were in phase Ⅲ and the rest 19(9.6%)cases were in phase Ⅳ.150 cases of phase Ⅰ and phase Ⅱ were divided into 7 groups randomly. Six groups ( 21±1 case each group ) were treated with tamoxifen, mifepristone,danazol,zoladex,destroy the focus by heating but no more than 100℃ or treated with placebo respectively, the seventh group and the Ⅲ～Ⅳ patients were treated by two step compound therapy, the first step was to destroy the focus, cut off ovarian cyst and separate the adherent tissue, then treated with danazol for 6 months. All patients were followed up and observed for one year to evaluate the effect and value.Results:Patients in Ⅰ、Ⅱ phase treated by tamoxifen, mifepristone, danazol, zoladex, destroying the focus by heating, two step therapy and placebo got a fertilizing rate of 34%,38%,54%,52%,42%,52.6%,8.1% respectively.Ⅲ phase patients′ fertilizing rate was 45.6% and Ⅳ phase patients′ was 48.7%. The dynamic analysis showed that the optimal time for fertilizing was 6～8 months after the therapies were finished.Conclusion:The infertility patients with endometriosis should be treated actively without considering their states.The suitable therapy is gonadotropic agents or two step compound therapy.The optimal observed period is 12 months.