腹腔镜手术治疗盆腔内子宫内膜异位症合并不孕症术后自然妊娠相关分析

目的 探讨腹腔镜手术治疗盆腔内子宫内膜异位症伴不孕症患者的术后妊娠率、妊娠结局及相关影响因素.方法 收集2010年1月-2014年12月行腹腔镜手术且术后病理确诊为盆腔内子宫内膜异位症合并不孕症的患者250例,回顾性分析其临床资料,随访其术后获得妊娠的时间、妊娠方式及妊娠结局等,并分析相关影响因素,随访时间为术后1~5年.结果 250例中,7例(2.8%)失访,随访的243例中,妊娠185例,其中自然妊娠148例(60.9%),体外受精-胚胎移植(IVF-ET)术妊娠37例.自然妊娠的148例中,于术后12月内妊娠者124例(83.8%).不同年龄的患者术后妊娠率及妊娠结局比较差别有统计学意义,<30岁者优于≥30岁者(P<0.05);术后妊娠率与卵巢子宫内膜异位囊肿侧别有关,右侧患者术后妊娠率高于左侧及双侧患者,差别有统计学意义(P<0.05);而不同r-AFS分期、不孕类型患者的术后妊娠率及妊娠结局比较差别则无统计学意义(P>0.05).结论 腹腔镜手术能有效提高盆腔子宫内膜异位症伴不孕症患者的术后妊娠率;术后1年是最佳的妊娠时间,年龄越大,术后妊娠率越低、妊娠结局越差.发生卵巢内膜异位囊肿的侧别可能与术后妊娠率有关;r-A FS分期、不孕类型对术后妊娠率及妊娠结局可能无明显影响.

Analysis on Influencing Factors of Pregnancy in Patients WhoUnderwent Laparoscopic Surgery for Endometriosis with Infertility

Objective To investigate the postoperative pregnancy rate ,pregnancy outcome and re-lated influencing factors of endometriosis with infertility treated by laparoscopic surgery . Methods We retrospectively analyzed patients undergoing laparoscopic surgery in the period of October 2010 to Decem-ber 2014 ,and we included patients whose postoperative pathology confirmed endometriosis and infertility . Their postoperative pregnancy time ,pregnancy outcome ,and influenced factors in one to five years were analyzed . Results There were 250 patients who met the criteria ,7 of whom failed to be followed up (2 .8% ) . Of the 243 patients ,185 were pregnant including 148 natural pregnant cases and 37 IVF-ET cases . Natural pregnancy rate was 60 .9% ,in which 124 cases (83 .8% ) got pregnant 12 months postop-eratively . Patients of different age showed significant different postoperative rate and outcome . Patients under 30 years old had better pregnancy rate and outcome than patients aged over 30 (P<0 .05) . Postop-erative pregnancy rate correlated with the side of ovarian cyst . Right side ovarian endometriotic cyst had statistically higher rate of pregnancy than that of left side or bilateral ovarian endometriotic cyst (P<0 .05) . There was no significant difference in postoperative pregnancy rate and pregnancy outcome between different r-AFS staging and infertility type (P>0 .05) . Conclusions Laparoscopic surgery can effectively improve the postoperative pregnancy rate for patients with endometriosis and infertility . The best pregnancy time is one year postoperatively . The older the patients ,the lower the postoperative pregnancy rate and the poorer outcome . Postoperative pregnancy rate is associated with the side of ovari-an cyst . r-AFS staging and infertility type has no significant effect on postoperative pregnancy rate and outcomes .