【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(píng)分系統(tǒng)對妊娠結(jié)局的預(yù)測價(jià)值?！》椒ā』仡櫺苑治?004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(jì)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(jì)學(xué)意義（Pgt;0.05）。根據(jù)美國生育協(xié)會(huì)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(jì)學(xué)意義（Pgt;0.05）；但隨著分期升高，活產(chǎn)率逐漸下降（Plt;0.05）。子宮內(nèi)膜異位癥生育指數(shù)（EFI）評(píng)分越高，其妊娠率和活產(chǎn)率也越高（Plt;0.05）?！〗Y(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(huì)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?！続bstract】 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 (Pgt;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) (Pgt;0.05), but the LBR decreased with the raising of the stages (Plt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (Plt;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.
目的探討腹腔鏡下子宮腺肌病病灶切除術(shù)聯(lián)合孕三烯酮治療子宮腺肌病的臨床療效及安全性。 方法回顧性分析2008年1月－2011年4月，診斷為子宮腺肌病并接受治療的82例患者的臨床資料。根據(jù)患者對治療方法的不同選擇分成3組，腹腔鏡子宮腺肌病病灶切除術(shù)聯(lián)合孕三烯酮治療27例，作為聯(lián)合組；單獨(dú)應(yīng)用腹腔鏡病灶切除術(shù)治療25例，作為手術(shù)組；單獨(dú)應(yīng)用孕三烯酮治療30例，作為藥物組。手術(shù)或用藥前后分別記錄患者的痛經(jīng)程度、月經(jīng)量、子宮體積、血清癌抗原125（CA125）、貧血及并發(fā)癥等情況。 結(jié)果3組患者治療后痛經(jīng)程度均得到緩解，聯(lián)合組與手術(shù)組治療后相比，痛經(jīng)程度、月經(jīng)量、子宮體積差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；聯(lián)合組與藥物組相比，痛經(jīng)程度差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；聯(lián)合組治療后12個(gè)月血清CA125水平、血紅蛋白水平與手術(shù)組相比，差異有統(tǒng)計(jì)學(xué)意義（P=0.019，P=0.049）。 結(jié)論腹腔鏡子宮腺肌病病灶切除術(shù)聯(lián)合孕三烯酮藥物治療，能緩解患者的臨床癥狀，近期療效顯著，但遠(yuǎn)期療效有待進(jìn)一步觀察。