宫腔镜联合腹腔镜治疗子宫内膜异位症合并不孕疗效及对术后妊娠的影响  

Efficacy of hysteroscopy combined with laparoscopy for treating infertility women with endometriosis and its influence on postoperative pregnancy

作　　者：田文秀 王晶 徐丹 黄艳丽[2] 兰艳丽[2] 刘韵[2] TIAN Wenxiu;WANG Jing;XU Dan;XING Hui;HUANG Yanli;LAN Yanli;LIU Yun(General Hospital of Central War Zone,Wuhan,Hubei Province,430070;Xiangyang Central Hospital of Hubei Province,Affiliated Hospital of Hubei University of Arts and Sciences)

机构地区：[1]中国人民解放军中部战区总医院,武汉430070 [2]湖北省襄阳市中心医院,湖北文理学院附属医院

出　　处：《中国计划生育学杂志》2020年第9期1467-1470,1474,共5页Chinese Journal of Family Planning

摘　　要：目的:探究宫腹腔镜联合治疗子宫内膜异位症伴不孕症疗效及对术后妊娠影响因素。方法:回顾性分析2016年5月-2017年5月本院收治的108例子宫内膜异位症伴不孕症患者的临床资料,根据治疗方案的不同分为宫腹腔镜组(n=57)和腹腔镜组(n=51),两组均于术后第1次月经2~5 d始给予促性腺释放激素激动剂(GnRH a)治疗6个月。比较两组患者术中出血量、手术时间、术后住院时间、术后2年妊娠率、临床疗效、并发症发生率,logistic回归分析患者术后妊娠相关影响因素。结果:宫腹腔镜组术中出血量、手术时间、术后住院时间与腹腔镜组无差异(P>0.05),治疗有效率(96.5%)及术后2年妊娠率(63.2%)高于腹腔镜组(80.4%、41.2%),并发症发生率(3.5%)低于腹腔镜组(15.7%)(P<0.05);两组患者年龄、BMI、不孕时间、盆腔手术史不同其术后妊娠情况无差异(P>0.05),子宫内膜异位症分期(r AFS分期)、输卵管畅通情况、应用辅助生殖技术情况、术后规范用药情况、手术治疗方案不同的患者术后妊娠情况有差异(P<0.05);多因素分析显示,子宫内膜临床r AFS分期Ⅲ~Ⅳ、输卵管不畅通、未使用辅助生殖技术、术后未规范用药是术后妊娠的危险因素(P<0.05),宫腹腔镜手术联合治疗是术后妊娠的保护因素(P<0.05)。结论:宫腹腔镜联合治疗子宫内膜异位症伴不孕症可显著提高术后妊娠率,安全有效。r AFS分期低(Ⅰ~Ⅱ期)、输卵管畅通、应用辅助生殖技术、宫腹腔镜手术联合治疗、术后规范用药等有助于提高患者术后妊娠率。Objective:To investigate the efficacy of hysteroscopy combined with laparoscopy for treating infertility women with endometriosis,and to study its influence on postoperative pregnancy.Methods:The clinical data of 108 infertility women with endometriosis from May 2016 to May 2017 were retrospectively analyzed.These women were divided into two groups according to different treatment schemes(51 cases in each group).The women in the control group underwent laparoscopic surgery,while the women in the study group underwent hysteroscopy combined with laparoscopy.After operation,the women in both groups were treated with gonadotropin releasing hormone agonist(GnRH a)on the 2nd to the 5th day after menstruation for 6 months.The intraoperative blood loss,operation time,postoperative hospital stay,pregnancy rate within postoperative 2 years,clinical efficacy,and complication rate of women were compared between the two groups.Logistic regression analysis were used to analyze the related influence factors of postoperative pregnancy.Results:There were no significant different in intraoperative blood loss,operative time,and postoperative hospital stay of women between the two groups(P>0.05).The effective rate(96.5%)and pregnancy rate within 2 years after operation(63.2%)of women in the study group were significant higher than those(80.4%and 41.2%)of women in the control group,but the incidence of complications(3.5%)of women in the study group was significant lower than that(15.7%)of women in the control group(P<0.05).There were no significant different in the age,BMI,infertility time,history of pelvic surgery,and postoperative pregnancy of women between the two groups(P>0.05),but there were significant different in the different stages of endometriosis(r AFS stage),the unblocked fallopian tube situation,the application of assisted reproductive technology,the standardized postoperative medication,and postoperative pregnancy of women after different surgical treatment scheme between the two groups(P<0.05).Multifactor analysis sho

关 键 词：子宫内膜异位症 宫腔镜联合腹腔镜手术 临床疗效 术后妊娠 影响因素 

分 类 号：R713[医药卫生—妇产科学]