张莉

[摘要] 目的 分析子宮内膜异位症（EMT）伴不孕症进行腹腔镜手术+孕三烯酮治疗的效果。 方法 选取2019年1月至2020年1月于山东省菏泽市牡丹人民医院治疗的EMT伴不孕症患者49例。以随机法为准，A组25例，予以腹腔镜手术+术后抗感染+孕三烯酮治疗;B组24例，予以腹腔镜手术+术后抗感染治疗，比较两组患者总有效率、子宫内膜厚度、VAS评分、性激素水平、治疗预后情况、不良反应发生情况及妊娠结局。结果 A组的总有效率为96.00%，高于B组的70.83%;治疗3个月后，A组的子宫内膜厚度小于B组，VAS评分低于B组，性激素水平低于B组，差异均有统计学意义（P<0.05）。A组的输卵管通畅率高于B组，妊娠率高于B组，差异有统计学意义（P<0.05）。A组的复发率接近B组，A组的不良反应总发生率略高于B组，差异无统计学意义（P>0.05）。A组的良好妊娠结局率为88.24%，高于B组的44.44%，不良妊娠结局率为11.76%，低于B组的55.56%，差异有统计学意义（P<0.05）。 结论 为EMT伴不孕症患者采取腹腔镜手术+孕三烯酮治疗能够恢复子宫功能，调节性激素水平，减轻痛感，且能提升输卵管通畅率和妊娠率，改善妊娠结局，同时不增加不良反应，安全性较佳。

[关键词] 子宫内膜异位症;不孕症;腹腔镜手术;孕三烯酮

[中图分类号] R711.71          [文献标识码] B          [文章编号] 1673-9701（2021）32-0078-04

[Abstract] Objective To analyze the therapeutic effect of laparoscopic surgery and gestrinone for endometriosis （EMT） combined with infertility. Methods A total of 49 EMT patients with infertility who were treated in Heze Mudan People′s Hospital， Shandong Province from January 2019 to January 2020 were selected as subjects. According to the random method， 25 patients in group A were treated with laparoscopic surgery+postoperative anti-infection+gestrinone; 24 patients in group B were treated with laparoscopic surgery+postoperative anti-infection， and the total effective rate， endometrial thickness， VAS score， sex hormone level， treatment prognosis， incidence of adverse reactions and pregnancy outcome were compared between the two groups. Results The total effective rate of group A（96.00%） was higher than that of group B（70.83%）. After 3 months of treatment， the endometrial thickness， VAS score and sex hormone level in group A were lower than those in group B， and the differences were statistically significant （P<0.05）. The tubal patency rate of group A was higher than that of group B， and the pregnancy rate of group A was higher than that of group B， with statistically significant differences （P<0.05）. The recurrence rate of group A was close to that of group B， and the total incidence of adverse reaction rate of group A was slightly higher than that of group B， with no statistically significant differences （P>0.05）. The rate of good pregnancy outcome in group A （88.24%） was higher than that in group B （44.44%）， and the rate of adverse pregnancy outcome in group A （11.76%） was lower than that in group B （55.56%）， with statistically significant differences （P<0.05）. Conclusion Laparoscopic surgery + gestrinone treatment for EMT patients with infertility can restore uterine function， regulate sex hormone levels， relieve pain， improve fallopian tube patency probability and pregnancy probability， improve pregnancy outcome， and show good safety， without increasing adverse reactions.

[Key words] Endometriosis; Infertility; Laparoscopic surgery; Gestrinone

子宫内膜异位症（Endometriosis，EMT）表现为间质或腺体等子宫内膜组织生长于子宫内膜之外的其他部位，且生物活性较佳。其症状表现为痛经、间歇式下腹痛、不孕和月经紊乱等[1]。其属于良性病变，但受生物学行为影响，同样能够浸润周围组织，复发率较高。数据显示，EMT的2年内疾病复发率约是30%，而EMT患者中，伴有不孕症的几率约为35%，无法生育的几率约为40%。……