宋豪 1 , 李慧 1 , 黃薇 2
  • 四川大學(xué)華西第二醫(yī)院（成都，610041）1 婦產(chǎn)科ICU，2 生殖內(nèi)分泌科;

【摘要】　目的　 觀察腹腔鏡手術(shù)聯(lián)合孕三烯酮治療子宮內(nèi)膜異位癥合并不孕的療效及不同評分系統(tǒng)對妊娠結(jié)局的預(yù)測價值。　方法　 回顧性分析2004年1月-2006年12月收治的97例子宮內(nèi)膜異位癥合并不孕患者的臨床病理資料，統(tǒng)計其術(shù)后妊娠率及活產(chǎn)率。　結(jié)果　 術(shù)后1年內(nèi)與1~2年的妊娠率與活產(chǎn)率比較，差異均無統(tǒng)計學(xué)意義（P gt;0.05）。根據(jù)美國生育協(xié)會1985年修訂的子宮內(nèi)膜異位癥分期標(biāo)準(zhǔn)（r-AFS）進(jìn)行分期，各期患者術(shù)后妊娠率差異無統(tǒng)計學(xué)意義（P gt;0.05）；但隨著分期升高，活產(chǎn)率逐漸下降（P lt;0.05）。子宮內(nèi)膜異位癥生育指數(shù)（EFI）評分越高，其妊娠率和活產(chǎn)率也越高（P lt;0.05）。　結(jié)論　 子宮內(nèi)膜異位癥患者腹腔鏡手術(shù)后聯(lián)用孕三烯酮可能會提高遠(yuǎn)期妊娠率。r-AFS分期對妊娠結(jié)局的預(yù)測有一定局限性，而EFI具有較好的預(yù)測性。
【Abstract】　Objective　 To evaluate the therapeutic effectiveness of laparoscopic surgery combined with gestrinone treatment in the infertile women with endometriosis (EM), and the value of different score systems to predict gestational outcome.　Methods　 We retrospectively analyzed the clinical data of 97 infertile women with EM who were treated in our hospital from January 2004 to December 2006, and collected their pregnancy rate (PR) and live birth rate (LBR) after operation.　Results　 There was no significant difference of PR and LBR within the 1st year and between the 1st and the 2nd year (P gt;0.05). There was no significant difference of PR among women of various stages of EM based on the 1985 edition of risk stratification for patients with EM put forward by American Fertility Society (r-AFS) (P gt;0.05), but the LBR decreased with the raising of the stages (P lt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (P lt;0.05).　Conclusion　 Laparoscopic surgery combined with gestrinone may increase the long-term pregnancy rate of women with EM. R-AFS classification is limited in predicting the gestational outcome of women with EM, while EFI achieves a better result.

引用本文： 宋豪,李慧,黃薇. 腹腔鏡手術(shù)聯(lián)合孕三烯酮治療子宮內(nèi)膜異位癥合并不孕的療效分析. 華西醫(yī)學(xué), 2011, 26(3): 382-384. doi: 復(fù)制

1. 　Suchy T, Stepan J. Extragenital endometriosis as a subject of interest for the surgeon[J]. Rozhl-Chir, 2004, 83(5): 239-241.
2. 　Jacobson TZ, Barlow DH, Koninckx PR, et al. Laparoscopic surgery for subfertility associated with endometriosis[J]. Coch Data Syst Rev, 2010, (1): CD001398.
3. 　Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery[J]. Coch Data Syst Rev, 2004, (3): CD003678.
4. 　岳軍, 楊榮秀. 腹腔鏡聯(lián)合藥物治療中重度子宮內(nèi)膜異位癥合并不孕癥的臨床分析[J]. 腹腔鏡外科雜志, 2006, 11(5): 397-399.
5. 　薛素華, 黃婉, 黃燕清. 腹腔鏡手術(shù)治療子宮內(nèi)膜異位癥伴不孕378例分析[J]. 中國微創(chuàng)外科雜志, 2003(3): 233-234.
6. 　America Fertility Society. Revised American Fertility Society Classification of endometriosis[J]. Fertil Steril, 1985, 43(3): 351-352.
7. 　Adamson GD, Pasta DJ. Pregnancy rates can be predicted by validated endometriosis fertility index(EFI)[J]. Fertil Steril, 2002, 77(Suppl 1): 48.
8. 　周應(yīng)芳. 子宮內(nèi)膜異位癥的臨床診斷和治療[J]. 中華婦產(chǎn)科雜志, 2005, 40(1): 67-70.
9. 　邢燕, 王璋, 劉嘉茵. 盆腔子宮內(nèi)膜異位癥手術(shù)后妊娠結(jié)局及復(fù)發(fā)情況[J]. 江蘇醫(yī)藥, 2006, 32(9): 852-853.
10. 　王娟, 覃愛平, 吳洪波, 等. 腹腔鏡聯(lián)合藥物治療輕度子宮內(nèi)膜異位合并不孕的臨床分析[J]. 中國計劃生育學(xué)雜志, 2008, 16(11): 682-684.
11. 　董其音. 子宮內(nèi)膜異位癥伴不孕患者術(shù)后妊娠情況142例分析[J]. 中國計劃生育學(xué)雜志, 2010, 18(2): 119-120.
12. 　Fuchs F, Raynal, Salama S, et al. Reproductive outcome after laparoscopic treatment of endometriosis in an infertile populatian[J]. Gynecol Obstet Biol Repord(Paris), 2006, 21: 2679-2685.
13. 　Vercellini P, Fedele L, Aimi1 G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system[J]. Hum Reprod, 2006, 21(10): 2679-2685.
14. 　Guzick DS, Silliman NP, Adamson GD, et al. Prediction of pregnancy in infertile women based on the American Society for reproductive medicine’s revised classification of endometriosis[J]. Fertil Steril, 1997, 67(5): 822-829.
15. 　Adamson GD, Pasta DJ. Endometriosis Fertility Index (EFI): the new, validated endometriosis staging system. Fertil Steril[J]. 2010, 94(5): 1609-1615.
  1. 1. 　Suchy T, Stepan J. Extragenital endometriosis as a subject of interest for the surgeon[J]. Rozhl-Chir, 2004, 83(5): 239-241.
  2. 2. 　Jacobson TZ, Barlow DH, Koninckx PR, et al. Laparoscopic surgery for subfertility associated with endometriosis[J]. Coch Data Syst Rev, 2010, (1): CD001398.
  3. 3. 　Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery[J]. Coch Data Syst Rev, 2004, (3): CD003678.
  4. 4. 　岳軍, 楊榮秀. 腹腔鏡聯(lián)合藥物治療中重度子宮內(nèi)膜異位癥合并不孕癥的臨床分析[J]. 腹腔鏡外科雜志, 2006, 11(5): 397-399.
  5. 5. 　薛素華, 黃婉, 黃燕清. 腹腔鏡手術(shù)治療子宮內(nèi)膜異位癥伴不孕378例分析[J]. 中國微創(chuàng)外科雜志, 2003(3): 233-234.
  6. 6. 　America Fertility Society. Revised American Fertility Society Classification of endometriosis[J]. Fertil Steril, 1985, 43(3): 351-352.
  7. 7. 　Adamson GD, Pasta DJ. Pregnancy rates can be predicted by validated endometriosis fertility index(EFI)[J]. Fertil Steril, 2002, 77(Suppl 1): 48.
  8. 8. 　周應(yīng)芳. 子宮內(nèi)膜異位癥的臨床診斷和治療[J]. 中華婦產(chǎn)科雜志, 2005, 40(1): 67-70.
  9. 9. 　邢燕, 王璋, 劉嘉茵. 盆腔子宮內(nèi)膜異位癥手術(shù)后妊娠結(jié)局及復(fù)發(fā)情況[J]. 江蘇醫(yī)藥, 2006, 32(9): 852-853.
  10. 10. 　王娟, 覃愛平, 吳洪波, 等. 腹腔鏡聯(lián)合藥物治療輕度子宮內(nèi)膜異位合并不孕的臨床分析[J]. 中國計劃生育學(xué)雜志, 2008, 16(11): 682-684.
  11. 11. 　董其音. 子宮內(nèi)膜異位癥伴不孕患者術(shù)后妊娠情況142例分析[J]. 中國計劃生育學(xué)雜志, 2010, 18(2): 119-120.
  12. 12. 　Fuchs F, Raynal, Salama S, et al. Reproductive outcome after laparoscopic treatment of endometriosis in an infertile populatian[J]. Gynecol Obstet Biol Repord(Paris), 2006, 21: 2679-2685.
  13. 13. 　Vercellini P, Fedele L, Aimi1 G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system[J]. Hum Reprod, 2006, 21(10): 2679-2685.
  14. 14. 　Guzick DS, Silliman NP, Adamson GD, et al. Prediction of pregnancy in infertile women based on the American Society for reproductive medicine’s revised classification of endometriosis[J]. Fertil Steril, 1997, 67(5): 822-829.
  15. 15. 　Adamson GD, Pasta DJ. Endometriosis Fertility Index (EFI): the new, validated endometriosis staging system. Fertil Steril[J]. 2010, 94(5): 1609-1615.