腹腔镜治疗子宫内膜异位症合并不孕症的疗效及影响术后妊娠的因素

目的]探讨腹腔镜治疗子宫内膜异位症合并不孕症的效果及影响术后妊娠的相关因素.方法]选取行腹腔镜手术治疗的卵巢子宫内膜异位症合并不孕症患者70例(观察组),另选取行开腹保守手术治疗的子宫内膜异位症合并不孕症患者60例为对照组.比较两组手术疗效并分析患者术后妊娠率的影响因素.结果]观察组手术时间、肛门首次排气时间均明显短于对照组,术中出血量也明显少于对照组,其差异均有统计学意义(P＜0.05);两组患者术后并发症发生率比较差异无统计学意义(P＞0.05).随访2年,观察组妊娠率明显高于对照组(P＜0.05).单因素分析结果显示,与观察组患者术后妊娠率密切相关的因素有r-AFS分期、术后输卵管通畅情况、术后联合用药及接受助孕;多因素逐步Logistic回归结果提示术后接受助孕、术后联合用药、输卵管通畅是影响腹腔镜治疗子宫内膜异位症合并不孕症患者术后妊娠率的独立因素.结论]采用腹腔镜手术治疗子宫内膜异位症合并不孕症,损伤小、术后恢复快,能有效提高患者的术后妊娠率.术后充分了解患者的输卵管通畅情况,及时联合用药,并适当进行助孕措施,对提高术后妊娠率有重要意义.

Curative Effect of Laparoscope in Treating Endometriosis Combined with Infertility and Factors Affecting Pregnancy after Operation

Objective]To investigate the curative effect of laparoscope in treating endometriosis combined with infertility and factors affecting pregnancy after the operation.Methods]A total of 70 patients who received laparoscopic opera tion in the treatment of ovarian endometriosis complicated with infertility were selected as the observation group and sixty cases of endometriosis with infertility who received conservative abdomen-open surgery were recruited as the control group.Clinical data,outcomes of surgery,and factors affecting the postoperative pregnancy of the two groups were analyzed.Results]The durations of the operation and the first postoperative exsufflation of the observation group were shorter than those of the control group,with statistically significant difference (P＜0.05).Postoperative complications of the two groups were not statistically significant different (P ＞0.05).During the 2 years of follow-up after surgery,the pregnancy rate of the observation group was higher than that of the control group (P ＜0.05).Univariate analysis showed that postoperative pregnancy rate of the observation group was closely related to factors including the R-AFS staging,postoperative tubal patency,postoperative combined medication and treatment for assisting pregnancy.Multivariate stepwise logistic regression results showed that treatment for assisting pregnancy,postoperative combined medication and tubal patency after the surgery were independent factors affecting postoperative pregnancy of patients with ovarian endometriosis complicated with infertility who were treated by laparoscopic operation.Conclusion] Laparoscopic surgery for endometriosis complicated with infertility has advantages of less injury and rapid recovery.To effectively improve the patient's postoperative pregnancy rate,it is of great significance to ensure tubal patency,timely combination of medication and other appropriate ways to boost the pregnancy.