韩春龙 王小红

[摘要] 目的 探讨腹腔镜联合GnRHa对不孕伴重度子宫内膜异位症患者的疗效。方法 方便收集2014年1月—2016年1月期间在该院因不孕症住院并经腹腔镜手术后病理确诊为重度EMT的患者100例，根据美国生育学会（AFS）提出的修正EMT分期系统[2]，符合III～IV期，单纯腹腔镜手术为对照组（n=40），同期手术后应用GnRHa治疗为联合组（n=60），随访1年，比较两组治疗后的复发率及自然妊娠率。 结果 联合组治疗后1年累计复发率23.3%，对照组累计复发率42.5%，联合组显著低于对照组，差异有统计学意义（χ2=5.234，P=0.019）;联合组治疗后的自然妊娠率是44.4%，对照组治疗后的自然妊娠率是30.0%，联合组自然妊娠率高于对照组，差异有统计学意义（χ2=6.216，P=0.025）。 结论 对于重度的子宫内膜异位症伴不孕的患者实行腹腔镜手术后应用GnRH-a疗效肯定，可以降低复发率，提高自然妊娠率。

[关键词] 重度子宫内膜异位症;腹腔镜;GnRHa

[中图分类号] R711          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0031-03

Laparoscopy Combined with GnRH-a in the Treatment of Infertility with Severe Endometriosis

HAN Chun-long， WANG Xiao-hong

Department of Gynecology， Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine（Fujian People's Hospital）， Fuzhou， Fujian Province， 350000 China

[Abstract] Objective To evaluate the efficacy of laparoscopy combined with GnRHa in patients with severe endometriosis. Methods A total of 100 patients with pathologically confirmed severe EMT after hospitalization for infertility and during laparoscopic surgery in the hospital from January 2014 to January 2016 were convenient recruited according to the revised EMT staging system proposed by the American Fertility Society（AFS）. In phase IV， simple laparoscopic surgery was used as a control group （n=40）， and GnRHa was used as a combined group （n=60） during the same period of follow-up. After 1 year of follow-up， the recurrence rate and natural pregnancy rate of the two groups were compared. Results The cumulative recurrence rate in the combined group was 23.3% at one year after treatment， and 42.5% in the control group. The combined group was significantly lower than the control group， the different was statistically significant（χ2=5.234，P=0.019）; the natural pregnancy rate after combined treatment was 44.4%. The natural pregnancy rate after treatment in the control group was 30.0%， and the natural pregnancy rate in the combined group was higher than that in the control group， the different was statistically significant （χ2=6.216，P=0.025）. Conclusion For patients with severe endometriosis and infertility， the efficacy of GnRH-a after laparoscopic surgery is positive， which can reduce the recurrence rate and increase the natural pregnancy rate.

[Key words] Severe endometriosis; Laparoscope; GnRHa

子宮内膜异位症（EMT）是指子宫内膜组织腺体和间质出现在子宫体以外部位而引起的一种病变，主要以疼痛和不孕为主要特征，不孕发生率高达40%～60%，是女性不孕症的重要原因之一[1]，且重度EMT患者中不孕的比例更高，随着二胎政策的开放，患者的生育要求越高，而宫腹腔镜术已成为诊治不孕症的重要手段，但对于重度EMT患者，单纯的手术治疗并不能彻底清除病灶，术后复发率较高，因此术后应用促性腺激素释放激素激动剂（GnRHa）可以降低术后复发率，提高自然妊娠率。该文方便收集2014年1月—2016年1月期间在该院因不孕症住院并经腹腔镜手术后病理确诊为重度EMT的患者100例为研究对象，旨在探讨腹腔镜联合药物治疗对重度子宫内膜异位症患者的临床价值及术后患者的自然妊娠率，为临床提供建议，现报道如下。……