子宫内膜异位症生育指数对子宫内膜异位症患者腹腔镜术后妊娠的预测价值

目的 评价子宫内膜异位症生育指数(endometriosis fertility index,EFI)对子宫内膜异位症(endometriosis,EMs)合并不孕患者腹腔镜术后自然妊娠的预测价值.方法 回顾性分析2012年6月至2014年6月在首都医科大学附属北京妇产医院进行腹腔镜手术的EMs合并不孕患者的病史及手术资料.按照EFI评分标准计算生育指数,采用Kaplan-Meier生存分析法计算不同分值患者术后3年内的累积妊娠率,并采用Log Rank检验进行比较.结果 EFI评分1～4分、5分、6分、7分、8分、9分、10分组3年累积妊娠率分别为14.3％、50.0％、66.7％、69.2％、73.7％、75.0％、83.3％,Log Rank检验结果显示,组间比较差异有统计学意义(x2=18.83,P=0.004).将不同EFI评分者进行合并分组,分为EFI 1～4分、EFI 5分及EFI 6～10分3组,各组3年内累积妊娠率分别为14.3％、50.5％、73.1％,Log Rank检验3组间比较差异有统计学意义(x2=18.106,P＜ 0.001).而不同r-AFS分期术后3年累积妊娠率分别为Ⅰ期79.1％,Ⅱ期63.6％,Ⅲ期58.5％,Ⅳ期66.7％,Log Rank检验结果提示,组间比较差异无统计学意义(x2=4.075,P=0.253).结论 与r-AFS分期相比,EFI评分能更好地预测EMs合并不孕患者腹腔镜术后3年内的妊娠情况,EFI评分越高,术后妊娠率越高.EFI评分对患者术后生育指导具有重要的临床意义.

The predictive value of the endometriosis fertility index for reproductive performance after laparoscopic surgery in endometriosis-associated infertility

Objective To evaluate the predictive value of endometriosis fertility index (EFI) for reproductive perforrnance after laparoscopic surgery in endometriosis(EMs)-associated infertility.Methods From Jun 2012 to June 2014,consecutive EMs associated with infertility patients who underwent laparoscopic surgery were studied retrospectively.EFI was calculated by history factors,least function(LF) score and r-AFS endometriosis stage.The cumulative pregnancy rate 3 years after surgery was calculated by Kaplan-Meier survival analysis,and compared by Log Rank test.Results Within 3 years after surgery,the cumulative pregnancy rates among patients with EFI score 1-4,5,6,7,8,9 and 10 were 14.3％,50.0％,66.7％,69.2％,73.7％,75.0％ and 83.3％ respectively,the Log Rank test showed statistical significant difference among the above sub-groups (x2=18.83,P =0.004).The subjects were divided into 3 groups according to EFI score,the cumulative pregnancy rate within 3 years of EFI 1-4,EFI 5 and EFI 6-10 were 14.3％,50.5％ and 73.1％,respectively.The difference among these 3 groups was statistically significant (x2=18.106,P ＜ 0.001).In contrast,the cumulative pregnancy rate within 3 years ofr-AFS stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 79.1％,63.6％,58.5％ and 66.7％ respectively.No statistical significant difference among these stages was found (x2=4.075,P =0.253).Conclusion EFI has been demonstrated to have better predictive value than r-AFS for reproductive performance after laparoscopic surgery in endometriosis-associated infertility.EFI is valuable to guide management decision upon post-surgical pregnancy.