【摘要】 目的 观察腹腔镜手术联合孕三烯酮治疗子宫内膜异位症合并不孕的疗效及不同评分系统对妊娠结局的预测价值。 方法 回顾性分析2004年1月-2006年12月收治的97例子宫内膜异位症合并不孕患者的临床病理资料，统计其术后妊娠率及活产率。 结果 术后1年内与1~2年的妊娠率与活产率比较，差异均无统计学意义（Pgt;0.05）。根据美国生育协会1985年修订的子宫内膜异位症分期标准（r-AFS）进行分期，各期患者术后妊娠率差异无统计学意义（Pgt;0.05）；但随着分期升高，活产率逐渐下降（Plt;0.05）。子宫内膜异位症生育指数（EFI）评分越高，其妊娠率和活产率也越高（Plt;0.05）。 结论 子宫内膜异位症患者腹腔镜手术后联用孕三烯酮可能会提高远期妊娠率。r-AFS分期对妊娠结局的预测有一定局限性，而EFI具有较好的预测性。【Abstract】 Objective To evaluate the therapeutic effectiveness of laparoscopic surgery combined with gestrinone treatment in the infertile women with endometriosis (EM), and the value of different score systems to predict gestational outcome. Methods We retrospectively analyzed the clinical data of 97 infertile women with EM who were treated in our hospital from January 2004 to December 2006, and collected their pregnancy rate (PR) and live birth rate (LBR) after operation. Results There was no significant difference of PR and LBR within the 1st year and between the 1st and the 2nd year (Pgt;0.05). There was no significant difference of PR among women of various stages of EM based on the 1985 edition of risk stratification for patients with EM put forward by American Fertility Society (r-AFS) (Pgt;0.05), but the LBR decreased with the raising of the stages (Plt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (Plt;0.05). Conclusion Laparoscopic surgery combined with gestrinone may increase the long-term pregnancy rate of women with EM. R-AFS classification is limited in predicting the gestational outcome of women with EM, while EFI achieves a better result.
ObjectiveTo explore the clinical effect and safety of laparoscopic cytoreductive surgery combined with gestrinone in the treatment of adenomyosis. MethodsWe retrospectively analyzed the clinical data of 82 patients with adenomyosis who accepted treatment in our hospital from January 2008 to April 2011. According to different treatment method, the patients were divided into three groups. Twenty-seven patients in the treatment group underwent laparoscopic cytoreductive surgery combined with postoperative treatment with gestrinone. For the 25 patients in the surgery group, only laparoscopic cytoreductive surgery was performed, and 30 other patients who only received oral gestrinone were designated as the medicine group. Dysmenorrhea, menstrual volume, uterine size, serum carcinoembryonic antigen 125 (CA125), anemia, and drug side effects were respectively recorded before and after surgery. ResultsThe dysmenorrhea degree reduced significantly in all the three groups. There was no significant difference in the degree of dysmenorrhea, menstrual volume, and uterine volume between the treatment group and the surgery group (P>0.05); the dysmenorrhea degree was significantly different between the treatment group and the medicine group (P<0.05); the differences in hemoglobin levels and the serum CA125 level between the treatment group and the surgery group 12 months later were significant (P=0.019, P=0.049). ConclusionThe laparoscopic cytoreductive surgery combined with gestrinone in treating adenomyosis can improve recent curative effect and provide more effective symptom control compared with surgery alone.