保守性手术治疗对不同类型子宫内膜异位症合并不孕的疗效探讨  

Efficacy Evaluation of Conservative Surgery for Different Types of Endometriosis Associated Infertility

作　　者：沈芳华[1] 袁蕾[1] 刘惜时[1] 郭孙伟[2] 

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]上海交通大学附属仁济医院妇产科研究所,上海200001

出　　处：《实用妇产科杂志》2008年第2期88-91,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨保守性手术以及手术联合药物治疗不同类型子宫内膜异位症合并不孕患者的疗效。方法：回顾性分析因子宫内膜异位症合并不孕而接受保守性手术治疗的患者共235例，随访12-36月（平均19．19±6．70月）。结果：198例完成随访，随访率84．26％（198／235）。术后妊娠率为35．86％（71／198），继发不孕者术后妊娠率明显高于原发不孕（54．55％ VS 26．52％，P〈0．001）。单纯腹膜型子宫内膜异位症、腹膜型联合卵巢内膜样囊肿合并不孕患者术后妊娠率明显高于腹膜型联合子宫腺肌病合并不孕患者（39．71％、37．96％ VS 13．64％，P〈0．05）。原发不孕和单纯腹膜型子宫内膜异位症合并不孕术后加用GnRH-a治疗组术后妊娠率高于未用药组（34．67％ VS 17．39％，58．62％ VS 25．71％，P〈0．05）。结论：①保守性手术可提高术后妊娠率，尤其对继发不孕；②手术对于单纯腹膜型子宫内膜异位症以及腹膜型联合卵巢内膜样囊肿合并不孕患者有明显的疗效；③原发不孕以及单纯腹膜型子宫内膜异位症患者术后加用GnRH-a治疗可以增加术后妊娠率。Objective： To evaluate the efficacy of conservative surgery or combined with drug therapy for different types of endometriosis assodaled infertility. Methods： Retrospectively reviewed 235 patients of endometriosis associated infertility who accepted conservative surgery from Jan 2003 to Dec 2005. Results：84.26 % （198/235） of patients were followed up for 12 to 36 months （ averagely 19.19 ＋/- 6.70 months）. The overall post-operative pregnancy rate was 35.86 %（ 71/198）. Secondary infertile patients had a higher pregnancy rate than pdmary infertile（54.55% VS 26.52%, P 〈0.001 ）. Patients. with simple peritoneal endometriosis or combined with ovarian ~ had higher pregnancy rate than those with adenomyosis （39.71%, 37.96% VS 13.64%, P〈 0.05）. Combined postoperative GnRH-a treatment had positive relationship with pregnancy rate in patients with primary infertile or simple peritoneal endometriosis.Conclusions： Cortservative surgery can promote pregnancy rate, especially in secondary infertile. Simple peritoneal endometdosis or combined with ovarian endometrioma have higher pregnancy rate. Combined post-operative GnRH-a treatment can promote pregnancy rate in patients of primary infertile or simple peritoneal endometdosis.

关 键 词：腹膜型子宫内膜异位症 卵巢内膜样囊肿 子宫腺肌病 不孕 GNRH-A 

分 类 号：R711.71[医药卫生—妇产科学]