腹腔镜术后联合GnRH-a治疗卵巢型内异症并不孕的疗效观察

目的:研究腹腔镜保守术后联合短期促性腺激素释放激素激动剂(GnRH-a)对卵巢型子宫内膜异位症合并不孕患者的治疗效果。方法:回顾性分析2008年5月-2011年5月在我院治疗内异症合并不孕的126例患者的临床资料,比较腹腔镜手术后联合GnRH-a治疗(用药组)和术后期待处理(对照组)的症状缓解率和妊娠情况。结果:用药组患者症状缓解率比对照组高,且差异有统计学意义(P0.05);用药组总妊娠率较对照组高,差异无统计学意义(P0.05),流产率比较无统计学差异(P0.05);治疗后患者1年内妊娠率最高,两组比较无统计学差异(P0.05),随访期间累积妊娠率比较,用药组高于对照组,无统计学意义(P0.05);用药组及对照组中Ⅰ-Ⅱ期及Ⅲ-Ⅳ期患者妊娠率均在50%以上,两组比较均无统计学差异(P0.05)。结论:此研究进一步明确腹腔镜术联合GnRH-a治疗卵巢子宫内膜异位症合并不孕患者能较好提高其症状缓解率和妊娠率,但妊娠率提高与期待治疗无差别。经手术或联合GnRH-a治疗后患者首次妊娠多发生在治疗后1年内,如果1年以上仍未妊娠,可根据实际情况选择其他助孕方法如辅助生育技术,以增加受孕机会。

Efficacy observation of Gonadotropin-releasing hormone agonist treatment after Laparoscopic Surgery in Ovarian Endometriosis-associated Infertility Patients

Objective： To study the efficacy of short-term gonadotropin-releasing hormone agonist （GnRH-a） treatment after la- paroscopic conservative surgery in Ovarian Endometriosis-associated infertility patients. Methods： The clinical data of 126 infertile pa- tients with ovarian endometriosis who received surgical therapy in the hospital from May 2008 to May 2011 were analyzed retrospectively, treatment group were treated with intravenous injection of GnRH-a for three courses after surgery, control group were encouraged to get pregnancy, the symptom relief rate and conception conditions in these two groups were observed. Results： The symptom relief rate in treatment group was higher than in control group, and the difference was statistically significant （P〈0.05）; Total pregnancy rate in treat- ment group was higher than in control group, but there was no significant difference （P〉0.05）; There was no significant difference （P〉0. 05） in abortion rate between two groups; The pregnancy rate was highest in the first year treatment in two groups with no statistically sig- nificant difference （P〉0.05）; Compared with control group, the cumulative pregnancy rate of treatment group was higher during fol- low-up （P〉0.05）; Pregnancy rate in stage Ⅰ - Ⅱ and Ⅲ-Ⅳ patients of two groups were more than 50% （P〉0.05）. Conclusion： This study further clarify laparoscopic surgery combined with GnRH-a treatment to ovarian endometriosis infertility patients can better improve their symptoms and pregnancy rates, but no difference in pregnancy rates with expectant treatment. Most of the pregnancy occurred in the first year after surgery or combined with GnRH-a therapy, considering the actual situation, other assisted reproductive methods such as assist- ed reproductive technology should be early encouraged for those patients remaining infertile for over one year after treatment, to increase the chances of conceiving.