李玉光 李红雨 鱼志琪 刘端 臧星卉

【摘要】 目的：探討子宫内膜异位症合并不孕患者腹腔镜术后影响妊娠的相关因素。方法：回顾分析2012年6月-2016年6月在本院妇科行腹腔镜手术且随访资料完整的178例内异症合并不孕患者的临床资料，采用Logistic回归分析法分析妊娠的相关影响因素。结果：178例患者中失访18例（10.1%），完整随访的160例患者中，术后共妊娠105例（65.6%）。其中自然妊娠82例，占78.1%（82/105）；辅助生育妊娠23例，占21.9%（23/105）。术后1年内妊娠者76例（72.4%），1～2年内妊娠者29例（27.6%）。使用GnRH-a者133例，其中妊娠97例，占72.9%（97/133）。单因素回归分析研究在月经天数、年龄、妊娠次数、术后使用GnRH-a治疗、既往妇科炎症、宫腔操作史与术后妊娠率差异均有统计学意义（P<0.05）。不同r-AFS分期与术后妊娠率差异无统计学意义（P>0.05）。多因素回归分析显示，月经天数≥5 d、既往妇科炎症、宫腔操作史≥2次，是术后不孕的危险因素。年龄、既往妊娠史、术后使用GnRH-a治疗可提高术后妊娠率（P<0.05）。结论：年轻患者，月经周期规律并缓解痛经，减少妇科炎症及不必要的宫腔操作，术后相关药物治疗，可提高术后妊娠率，有效预防子宫内膜异位症的发生。

【关键词】 子宫内膜异位症； 不孕； 妊娠

【Abstract】 Objective：To investigate the influential factors of pregnancy after laparoscopic surgery in patients with endometriosis and infertility.Method：From June 2012 to June 2016 in gynecological laparoscopic surgery and follow-up data of 178 patients with endometriosis and infertility were retrospectively analyzed，using Logistic regression analysis method to analyze the related factors of pregnancy.Result：There were lost 18 cases（10.1%）.160 patients with complete follow-up patients had 105 cases（65.6%） of pregnancy after surgery.The natural pregnancy had 82 cases，accounting for 78.1%（82/105），assisted reproduction pregnancy had 23 cases，accounting for 21.9%（23/105）.76 cases（72.4%） were pregnant within 1 year after the operation，

29 cases（27.6%） were pregnant in 1 to 2 years.The use of GnRH-a in 133 cases，of which 97 cases had pregnant，accounting for 72.9%（97/133）.Single factor regression analysis in the number of days，age，number of pregnancies，postoperative use of GnRH-a treatment，the previous gynecological inflammation，uterine cavity operation and postoperative pregnancy rate differences were statistically significant（P<0.05）.Different r-AFS staging and postoperative pregnancy rate had no significant difference（P>0.05）.Multivariate regression analysis showed that more than 5 days menstrual days，previous gynecological inflammation，uterine cavity operation history of more than 2 times were risk factors for infertility.Age，previous pregnancy history and postoperative use of GnRH-a treatment can improve the postoperative pregnancy rate（P<0.05）.Conclusion：Young patients，menstrual cycle and alleviate dysmenorrhea，decrease gynecological inflammation and unnecessary uterine cavity operation，postoperative related drug treatment，can improve the postoperative pregnancy rate，and prevent the occurrence of endometriosis effectively.

【Key words】 Endometriosis； Infertility； Pregnancy

First-authors address：The Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China

doi：10.3969/j.issn.1674-4985.2018.05.016

子宫内膜异位症（endometriosis，EMs）是指子宫内膜组织（腺体和间质）在子宫腔被覆内膜及子宫以外的部位出现、生长、浸润，反复出血，继而引发疼痛、不孕及结节或包块等[1-2]。根据文献[3]统计：3%～10%的生育期女性患有内异症，不育合并慢性盆腔疼痛患者中40%～80%是EMs，很多无症状妇女在不孕检查时诊断为子宫内膜异位症占到40%～50%。其中子宫内膜异位症患者不育是正常人群的20倍。同时不明原因不育的人中有1/3患有EMs。内异症和不孕的联系机制尚不清楚，可能的机制有：（1）影响排卵和黄体功能，降低卵巢功能；（2）引起盆腔粘连，输卵管扭曲、阻塞；（3）对受精卵和胚胎有毒害作用；……