腹腔镜术后Ⅰ～Ⅱ期盆腔子宫内膜异位症不孕患者的临床治疗观察

目的寻找Ⅰ～Ⅱ期盆腔子宫内膜异位症不孕症患者腹腔镜术后最合适的助孕方案。方法收集2009年3月至2011年3月间在本院住院行腹腔镜手术的子宫内膜异位症不孕患者共437例,其中298例Ⅰ~Ⅱ期患者纳入本研究,并且区分为原发不孕组和继发不孕组。腹腔镜术后按照不同尝试怀孕方式分为自然周期、促排卵周期以及人工授精周期组。汇总资料后分别比较两种类型不孕患者采取三种助孕方式临床治疗效果。另外还研究比较两种不孕类型子宫内膜异位症术后1年累积妊娠情况。结果原发和继发不孕患者术后采用三组不同助孕方式间周期临床妊娠率差异有统计学意义(P=0.032和P=0.034),均为人工授精组最高,自然周期组最低。而周期妊娠率、早期流产率、异位妊娠率及双胎妊娠率在三组间比较,差别无统计学意义(P>0.05)。但人工授精周期妊娠率相对有明显增高趋势。原发不孕与继发不孕的子宫内膜异位症比较,累积妊娠率(64%vs.81.2%)与累积临床妊娠率(53.8%vs.69.3%)均较低,差别有统计学意义(P<0.05)。而此两组间早期流产率、异位妊娠率以及双胎妊娠率差异均无统计学意义(P>0.05)。结论Ⅰ、Ⅱ期子宫内膜异位症患者在腹腔镜术后妊娠结果是良好的,结合促排卵方案人工授精技术可以得到更高的临床妊娠结局。

Clinical Observation of Stage I - II Endometriosis Infertility after Laparoscopic Surgery

Objective To look for the most appropriate assisted reproduction protocol for infertility patients with stage I to I pelvic endometriosis after laparoscopic surgery. Methods 437cases of infertility patients with endometfiosis who have taken laparoscopic surgery are collected in our hospital from March 2009 to March 2011. Among them, 298patients enrolled in this study. They were divided into primary infertility group and secondary infertility group. According to the different attempts to pregnancy, they were then divided into three groups of natural cycle, ovulation induction and insemination. We compared the clinic outcome of the three groups respectively. The cumulative pregnancy rates of I year after surgery between two types of endometriosis infertility patients were also compared. Results The clinical pregnancy rate per cycle by using the three different therapeutic attempts was statistically significant different both in primary and secondary infertility patients after laparoscopic surgery （P=0.032andP=0.034）. The clinical pregnancy rate in 1UI group was higher than the natural cycle and induction groups. There were no statistically significant difference in pregnancy rate per cycle, miscarriage rate, ectopic pregnancy rate and twin pregnancy rate between the three treatment groups （P〉0.05）. But the cycle pregnancy rate of artificial insemination had a significant increasing trend. There were significant difference in the cumulative pregnancy rate per cycle （64%vs.81.2%） and cumulative clinical pregnancy rates （53.8%vs.69.3%） between the two groups （P〈0.05）. The early abortion rate, ectopic pregnancy rate and twin pregnancy rate had no statistical difference （P〉0.05）. Conclusions The pregnancy outcome of stage I - II endometriosis patients seemed good after laparoscopy surgery. We can get higher clinical pregnancy rate by using artificial insemination technique with ovulation induction protocol.