摘要
目的探讨保守性手术后卵巢子宫内膜异位症(endometriosis,EMT)患者的自然妊娠情况。方法选取2019年6月—2022年1月于深圳市妇幼保健院收治的116例卵巢EMT患者为研究对象,进行回顾性分析。根据患者术后2年内是否成功自然妊娠分为妊娠组和未妊娠组。分析患者年龄、囊肿位置、体质指数(body mass index,BMI)、合并疾病、囊肿直径、术后促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonists,GnRH-a)治疗情况、美国生殖医学协会子宫内膜异位症分期(the revised classification American Fertility Society,r-AFS)评分、子宫内膜异位症生育指数(endometriosis fertility index,EFI)评分,并进行logistic回归分析卵巢EMT患者腹腔镜术后自然妊娠成功的影响因素。结果经12~24个月随访发现,116例卵巢EMT患者术后自然妊娠55例,自然妊娠率为47.4%,未自然妊娠61例,未自然妊娠率为52.6%。经单因素分析结果显示,卵巢EMT患者术后自然妊娠与BMI、合并疾病、囊肿直径无关(P>0.05);与年龄、囊肿位置、术后GnRH-a治疗、r-AFS分期、EFI评分有关(P<0.05)。经过多因素logistic回归分析显示,与年龄≤35岁的卵巢EMT患者相比,年龄>35岁的卵巢EMT患者自然妊娠率更低(P<0.05);与囊肿位置左侧的卵巢EMT患者相比,囊肿位置右侧及双侧的卵巢EMT患者自然妊娠率更低(P<0.05);与术后进行GnRH-a治疗的患者相比,术后未进行GnRH-a治疗的卵巢EMT患者自然妊娠率更低(P<0.05);与r-AFS分期Ⅰ~Ⅱ期的卵巢EMT患者相比,r-AFS分期Ⅲ期和Ⅳ期的卵巢EMT患者自然妊娠率更低(P<0.05)。故年龄>35岁、囊肿位置为右侧及双侧、r-AFS分期为Ⅲ期和Ⅳ期是卵巢EMT患者自然妊娠的危险因素,术后GnRH-a治疗是其保护因素。结论通过筛查卵巢EMT患者腹腔镜术后自然妊娠的影响因素发现,高龄、双侧囊肿、r-AFS高分期是其危险因素,术后GnRH-a治疗是其保护因素,可于早期通过开展干预措施,提高术后自然妊娠率。
Objective To investigate natural pregnancy occurrence among patients with endometriosis(EMT)after conservative surgery.Methods 116 patients with ovarian EMT admitted to Shenzhen Maternity&Child Healthcare hospital from June 2019 to January 2022 were recruited as research subjects,their data were analyzed retrospectively.The patients were divided into pregnant group and non-pregnant group according to whether they had a successful spontaneous pregnancy within 2 years after surgery.Patients’age,cyst location,body mass index(BMI),co-morbidities,cyst diameter,postoperative gonadotropin-releasing hormone agonist(GnRH-a)treatment,the revised classification American Fertility Society(r-AFS)stage,and the score of endometriosis fertility index(EFI)were analyzed.Logistic regression analysis was performed to analyze factors associated with successful natural pregnancy among patients with ovarian EMT after laparoscopic surgery.Results After 12 to 24 months of follow-up,55 in 116 patients(47.4%)with ovarian EMT conceive spontaneously post-surgery,while 61 cases(52.6%)failed to conceive naturally.Univariate analysis showed that spontaneous pregnancy after ovarian EMT surgery was not associated with BMI,co-morbidities and cyst diameter(P>0.05),but it was associated with age,cyst location,postoperative GnRH-a treatment,r-AFS stage and EFI score.Logistic regression analysis showed that compared with patients aged≤35 years,patients aged>35 years had lower natural pregnancy rates(P<0.05);Compared with patients with ovarian EMT on the left side,patients with that on the right and both sides had lower natural pregnancy rates(P<0.05);Compared with patients who underwent postoperative GnRH-a treatment,those without GnRH-a treatment had lower natural pregnancy rates(P<0.05);Compared with r-AFS stageⅠ-Ⅱovarian EMT patients,r-AFS stageⅢandⅣpatients had lower natural pregnancy rates(P<0.05).Therefore,age>35 years old,right and bilateral cyst location,and r-AFS stageⅢandⅣwere risk factors,while postoperative GnRH-a treatment was a protective factor for spontaneous pregnancy among patients with ovarian EMT.Conclusion Our study suggests that senior age,bilateral cysts and progressed stage of r-AFS are risk factors,while GnRH-a treatment is protective factor for natural pregnancy after laparoscopic ovarian EMT.Early intervention measures can be carried out to improve the rate of postoperative spontaneous pregnancy.
作者
于敬会
姚秀华
YU Jing Hui;YAO Xiu Hua(Shenzhen Maternity&Child Healthcare Hospital,Shenzhen 518000,Guangdong Province,China)
出处
《中国妇幼卫生杂志》
2023年第1期59-63,共5页
Chinese Journal of Women and Children Health
