宫腹腔镜治疗子宫内膜异位症合并不孕患者的效果  

Efficacy of hysteroscopy combined with laparoscopy in treatment of endometriosis combined with infertility

作　　者：方明珠[1] 郭华峰[1] 郭宝芝[1] 丁书贵[1] 刘爱珍[1] 

机构地区：[1]河南省郑州市妇幼保健院妇科,450012

出　　处：《中国妇幼保健》2014年第19期3106-3108,共3页Maternal and Child Health Care of China

基　　金：2012年郑州市科技攻关计划资助项目〔121PLJRC539〕

摘　　要：目的：探讨子宫内膜异位症合并不孕患者宫-腹腔镜保守性手术后1～2年的自然妊娠率及术后复发情况。方法：回顾性分析2007年1月～2012年2月就诊的不孕症妇女,经腹腔镜确诊的262例子宫内膜异位症合并不孕的患者实施腹腔镜保守性手术,术后随访1～2年,观察妊娠及术后复发情况。结果：262例患者中108例（41.22%）在为期2年的自然排卵周期中成功妊娠。按AFS分期,Ⅰ～Ⅳ期各组累积妊娠率分别为43.53%、43.63%、41.76%和29.03%。各期之间妊娠率没有统计学差异,但Ⅳ期组的妊娠率相对较低（29.03%）;各组术后1年内的妊娠率明显高于术后1～2年。子宫直肠陷凹闭锁患者术后妊娠率（21.82%）和输卵管周围/卵巢周围粘连者妊娠率（32.86%）明显低于单纯卵巢型（50.97%）及浅表腹膜型妊娠率（60.61%）。结论：子宫内膜异位症合并不孕患者宫-腹腔镜保守性手术后1年内是妊娠的最佳时机,子宫直肠陷凹闭锁和输卵管周围/卵巢周围粘连,对预测术后妊娠率可能有一定价值。Objective： To explore the natural pregnancy rate and postoperative recurrence of infertile patients with endometriosis during the first 1 -2 years after conservative surgery （hysteroscopy combined with laparoscopy） . Methods： The infertile women were ana- lyzed retrospectively from January 2007 to February 2012, 262 infertile patients with endometriosis diagnosed definitely by laparoscopy under- went laparoscopie conservative surgery, and the patients were followed up for 1 -2 years, the pregnancy outcome and postoperative recur- rence were observed. Results： Among 262 patients, 108 patients （41. 220/0 ） got pregnancy successfully during natural ovulation cycles within two years; according to AFS staging, the accumulative pregnancy rates of stages I - IV were 43.53% , 43.63% , 41.76% and 29. 03 %, respectively; there was no statistically significant difference in the pregnancy rate among patients of different stages, but the preg- nancy rate of stage IV was relatively low （29. 03% ） ; the regnaney rate within one year after surgery was significantly higher than that at 1 - 2 years after surgery; the postoperative pregnancy rates of patients with reetouterine fossa obliteration and peritubaL/subovarian adhesion were 21.82% and 32. 86%, respectively, which were statistically significantly lower than those of patients with simple ovarian type endometriosis （50. 97% ） and superficial peritoneal type eudometriosis （60. 61% ） . Conclusion： The best time to pregnancy for infertile patients with endometriosis is the first one year after conservative surgery （hysteroscopy combined with laparoscopy） , rectouterine fossa obliteration and peritubal/subovarian adhesion may have a certain value in predicting postoperative pregnancy rate.

关 键 词：子宫内膜异位症 不孕症 腹腔镜检查 宫腔镜检查 妊娠率 

分 类 号：R713[医药卫生—妇产科学]