腹腔镜下子宫内膜异位症生育指数在子宫内膜异位症合并不孕中的应用研究

目的:探讨腹腔镜下子宫内膜异位症生育指数(EFI)对子宫内膜异位症(EMT)合并不孕患者的生育力评估的临床价值。方法:回顾性分析在我院进行腹腔镜手术治疗的EMT合并不孕、随访资料完整的118例患者的临床资料进行EFI评分,随访术后妊娠情况。结果:118例患者术后3年累积妊娠率为46.6%;术后第1、2、3年的妊娠率分别为28.8%、14.4%和3.4%,组间比较差异有统计学意义(P<0.05)。EFI评分9～10分、5～8分、≤4分者的术后3年累积妊娠率分别为76.2%、47.4%、10.5%,术后3年累积妊娠率与EFI评分、术后使用促排卵药物治疗呈正相关(tau-b=0.367,0.439;P<0.01);与美国生育协会修订的EMT分期(r-AFS)标准及使用促性腺激素释放激素激动剂(GnRH-a)无相关性(tau-b=0.006,0.076;P>0.05)。不同临床类型的术后3年累积妊娠率间两两比较,差异均无统计学意义(P>0.05)。结论:腹腔镜下EFI评分用于评估EMT合并不孕患者的生育力,指导后续治疗有重要的参考意义,可根据EFI评分,综合评估患者的生育状况,选择个体化的后续治疗方案;EMT合并不孕患者不建议长期期待以提高患者的妊娠率。

Application of Laparoscopic Endometriosis Fertility Index in Patients with Endometriosis-Associated Fertility

Objective:To investigate the clinical application of laparoscopic endometriosis fertility index (EFI) and its predicting value of fertility outcome in patients with endometriosis-associated infertility.Methods:118 patients with endometriosis-associated infertility who underwent laparoscopic treatment in our hospital were followed up to assess fertility outcome.Meanwhile,EFI scores were obtained during laparoscopic procedure.The clinical data was analyzed retrospectively.Results:The overall postoperative pregnancy rate within 36 months was 46.6%.The postoperative pregnancy rate was 28.8%,14.4% and 3.4% in the first,the second and the third year respectively.There were significant differences among the three groups(P<0.05).The postoperative pregnancy rate of patients whose EFI scoring 9～10,5～8 and ≤4 was 76.2%,47.4% and 10.5% respectively.The postoperative pregnancy rate was positively correlated with EFI scoring and ovarian stimulation treatment(P<0.01).However,the postoperative pregnancy rate had no correlation with r-AFS staging,EMT categories and GnRH-a treatment (P>0.05).Conclusions:EFI is proved to be very valuable in predicting the fertility outcome and in selecting the follow-up treatment in patients with endometriosis-associated infertility after laparoscope surgery.Therefore,comprehensive evaluation of the fertility outcome based on EFI after laparoscopic surgery is preferable in patients of endometriosis-associated infertility.Meanwhile,therapeutic selection should be individualized.To improve the pregnancy rate of patients with endometriosis,long term expectant management is not recommended.