超声引导下穿刺联合亮丙瑞林治疗中重度卵巢型子宫内膜异位症患者术后妊娠结局的影响因素分析

目的 研究超声引导下穿刺联合亮丙瑞林促性腺激素释放激素激动剂（gonadotrophin releasing hormone agonist，GnRHa） 治疗中重度卵巢型子宫内膜异位症患者术后妊娠结局的影响因素。 方法 选取我院收治的重度卵巢型子宫内膜异位患者120例为研究对象。所有患者均进行超声引导下穿刺术，亮丙瑞林组62例术后加用亮丙瑞林进行治疗。对患者进行随访，记录患者的妊娠率。对患者妊娠成功与妊娠失败患者的年龄、不孕年限、囊肿直径、囊肿单/多发性、生育指数（fertility index ，EFI）和术前CA125、血清抗苗勒管激素（serum anti-müllerian hormone ，AMH）水平、双侧/单侧卵巢受累等指标进行记录。 结果 随访结束，所有患者均到访，随访率100%。亮丙瑞林组妊娠率高于非亮丙瑞林组（P＜0.05）。亮丙瑞林组的复发率低于非亮丙瑞林组（P＜0.05）。二元Logistic回归分析显示，术后GnRHa的使用、术前AMH水平、双侧卵巢受累及存在多个囊腔是影响患者妊娠成功的独立影响因素（P＜0.05）。 结论 超声引导下穿刺联合亮丙瑞林治疗中重度卵巢效果显著，患者术后GnRHa的使用、术前AMH水平、双侧卵巢受累及存在多个囊腔是影响患者术后妊娠成功的影响因素。

Analysis of influencing factors of postoperative pregnancy outcome in patients with moderate to severe ovarian endometriosis treated with ultrasound-guided puncture combined with leuprolide

Objective To study the influencing factors of postoperative pregnancy outcome in patients with moderate to severe ovarian endometriosis treated by ultrasound-guided puncture combined with leuprolide.Methods In total, 120 patients with severe ovarian endometriosis admitted to our hospital were enrolled in this study. All patients underwent ultrasound-guided puncture, and 62 patients in the leuprorelin group were supplemented with leuprorelin after operation. The patients were followed up and their pregnancy rate was recorded. The age, duration of infertility, diameter of cyst, single/multiple cyst, endometriosisfertility index(EFI) and preoperative CA125, serum anti-Müllerian hormone(AMH) level, bilateral/unilateral ovarian involvement of patients with successful pregnancy and pregnancy failure were recorded.Results At the end of follow-up, all patients were visited, and the follow-up rate was 100%. The pregnancy rate of leuprorelin group was higher than that of non-leuprorelin group(P＜0.05). The recurrence rate of leuprorelin group was lower than that of non-leuprorelin group(P＜0.05). Binary Logistic regression analysis showed that the use of GnRHa after operation, the level of preoperative AMH, bilateral ovarian involvement and the presence of multiple cysts were the independent influencing factors of pregnancy success(P＜0.05).Conclusion Ultrasound-guided puncture combined with leuprorelin is effective in the treatment of moderate to severe ovarian endometriosis. The use of GnRHa, preoperative AMH level, bilateral ovarian involvement, and the presence of multiple cysts are the influential factors that affect the success of pregnancy after surgery.