子宫内膜异位症生育指数在腹腔镜手术后的子宫内膜异位症合并不孕患者中的应用价值  

Evaluation of endometriosis fertility index in follow-up treatment of endometriosis combined with infertility patients after laparoscopic surgery

作　　者：钱睿亚[1] 吴霞[1] 盛洁[1] 郑萍[1] 周琦[1] 段爱红[1] 张建萍[1] 张亚兰[1] 卢丹[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,100026

出　　处：《中华妇产科杂志》2017年第4期233-238,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：首都卫生发展科研专项（首发2016-1-2111）;首都医科大学附属北京妇产医院课题基金（201015）

摘　　要：目的应用子宫内膜异位症（内异症）生育指数（EFI）对腹腔镜术后的内异症合并不孕患者进行不同分组并指导妊娠，探索提高内异症合并不孕患者术后妊娠率的方法。方法应用EFI对2010年1月至2011年6月在首都医科大学附属北京妇产医院行腹腔镜手术且配合随访治疗的146例内异症合并不孕的患者进行前瞻性研究，分为EFI≥9分、5—8分、≤4分3组并制定不同的妊娠方案，术后随访5年，统计妊娠率及妊娠结局。结果（1）术后5年总妊娠率为89．0％（130／146）；I〉9分组的累积妊娠率达95．7％（45／47），5~8分组的累积妊娠率达92．8％（77／83），≤4分组为8／16，3组均获得了满意的妊娠率；／〉9分组与5—8分组的妊娠率无差异（P=0．498），但两组与≤4分组比较，差异有统计学意义（P〈0．01）。（2）EFI≥5分的患者术后月经复潮后或促性腺激素释放激素激动剂（GnRH．a）治疗后月经复潮6个月内妊娠的比例高；／〉9分组术后6个月内妊娠的比例最高[66．7％（30／45）]，5～8分组6个月内妊娠的比例为50．6％（39，77）。（3）／〉9分组自然妊娠率最高[83．6％（46／55）]，可期待妊娠至术后月经复潮后或GnRH．a治疗后月经复潮后1年；3组的自然妊娠率比较，差异有统计学意义（P=0．001）。结论EFI评分对预估并指导内异症合并不孕患者术后妊娠有积极意义。根据EFI评分，对内异症合并不孕的患者术后进行严格管理并制定积极的妊娠方案能显著提高此类患者的妊娠率。Objective To explore the application of endometriosis fertility index （EF1） in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results （1） The 5 years overall pregnancy rate was 89.0% （130/146）. The pregnancy rate was 95.7% （45/47） in EFI≥9 group, 92.8% （77/83） in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate; the rate of the first two groups had no statistically significance （P=0.498）, but had significant difference with the last group （P〈O.O1）. （2） In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation; in EFI≥9 group, the pregnancy rate was 66.7% （30/45）, and EFI 5-8 group was 50.6% （39/77）. （3） EFI≥9 group had the highest natural pregnancy rate [83.6% （46/55）], natural pregnancy rate was significant statistical different in different EFI groups （P=0.001）. Conclusions EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could signifieantly improve the pregnancy rate of endometriosis patients with infertility.

关 键 词：子宫内膜异位症 腹腔镜检查 不育 女(雌)性 疾病严重程度指数 临床方案 妊娠率 子宫内膜异位症生育指数 

分 类 号：R713[医药卫生—妇产科学]