子宫内膜异位症合并不孕患者腹腔镜保守治疗术后联用GnRHa对妊娠结局影响
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摘要
目的:探析子宫内膜异位症(EMT)合并不孕患者腹腔镜保守治疗术后联用GnRHa对妊娠结局影响。方法:回顾分析本院2013年7月—2017年7月收治EMT合并不孕患者228例,依据治疗方案不同分组,观察组(n=114)行腹腔镜保守治疗术联用GnRHa治疗,对照组(n=114)常规腹腔镜保守治疗术。对患者内膜异位进行r-AFS分期。监测两组患者术前、术后1、3、6、12个月癌胚抗原125(CA125)水平;随访36个月记录妊娠率及妊娠结局。结果:观察组r-AFSⅢ期、Ⅳ期及总体妊娠成功率均高于对照组,早期流产率低于对照组,足月产率高于对照组(均P>0.05);两组异位妊娠、早产及分娩方式比较无差异(P>0.05),术后CA125均低于术前(P<0.05),且观察组术后1、3、6个月CA125水平低于对照组(P<0.05);EMT复发率观察组(4.4%)与对照组(7.9%)无差异(P>0.05)。结论:腹腔镜保守治疗术后联用GnRHa可提升中重度EMT不孕者妊娠成功率,治疗6～12个月内为妊娠关键期,盆腔环境、卵巢功能的改善有助于优化卵泡和胚胎质量,改善妊娠结局。
Objective: To investigate the influence of GnRHa combined with laparoscopic for conservative treating infertility women with endometriosis(EMT) on the pregnancy outcomes. Methods: The data of 228 infertility women with EMT from July 2013 to July 2017 were retrospective analyzed. According to different treatment schemes, the women in the observation group(114 cases) were treated by laparoscopic conservative therapy combined with GnRHa, while the women in the control group(114 cases) were only treated by laparoscopic conservative therapy. r-AFS staging was performed for all included women. The serum levels of carcinoembryonic antigen 125(CA125) of all women were monitored before and 1, 3, 6, 12 month after operation. After followed up for 36 months, the pregnancy rate and pregnancy outcomes of women were recorded. Results: The rates of stage Ⅲ and Ⅳ r-AFS, pregnancy rate, and term delivery rate of women in the observation group were higher than those of women in the control group, and the abortion rate was lower, but there were no significant different between the two groups(P>0.05). There were no significant difference in the rates of ectopic pregnancy and preterm birth, and mode of delivery between the two groups(P>0.05). After operation, the level of CA125 of all women had decreased significantly(P<0.05), and that of women in the observation group was significant lower than that of women in the control group at 1, 3, and 6 months after operation(P<0.05). The recurrence rate of EMT was 4.4% of women in the observation group, which had no significant different from that(7.9%) of women in the control group(P>0.05). Conclusion: Conservative laparoscopic therapy combined with GnRHa can improve the success pregnancy rate of infertility women with moderate and severe EMT, and 6-12 months after treatment is a critical period for pregnancy, which is helpful to optimize the quality of follicles and embryos,and to improve the pregnancy outcomes by improving pelvic environment and ovarian function.
Objective: To investigate the influence of GnRHa combined with laparoscopic for conservative treating infertility women with endometriosis(EMT) on the pregnancy outcomes. Methods: The data of 228 infertility women with EMT from July 2013 to July 2017 were retrospective analyzed. According to different treatment schemes, the women in the observation group(114 cases) were treated by laparoscopic conservative therapy combined with GnRHa, while the women in the control group(114 cases) were only treated by laparoscopic conservative therapy. r-AFS staging was performed for all included women. The serum levels of carcinoembryonic antigen 125(CA125) of all women were monitored before and 1, 3, 6, 12 month after operation. After followed up for 36 months, the pregnancy rate and pregnancy outcomes of women were recorded. Results: The rates of stage Ⅲ and Ⅳ r-AFS, pregnancy rate, and term delivery rate of women in the observation group were higher than those of women in the control group, and the abortion rate was lower, but there were no significant different between the two groups(P>0.05). There were no significant difference in the rates of ectopic pregnancy and preterm birth, and mode of delivery between the two groups(P>0.05). After operation, the level of CA125 of all women had decreased significantly(P<0.05), and that of women in the observation group was significant lower than that of women in the control group at 1, 3, and 6 months after operation(P<0.05). The recurrence rate of EMT was 4.4% of women in the observation group, which had no significant different from that(7.9%) of women in the control group(P>0.05). Conclusion: Conservative laparoscopic therapy combined with GnRHa can improve the success pregnancy rate of infertility women with moderate and severe EMT, and 6-12 months after treatment is a critical period for pregnancy, which is helpful to optimize the quality of follicles and embryos,and to improve the pregnancy outcomes by improving pelvic environment and ovarian function.
引文
[1] 李灵香.子宫内膜异位症的发病原因及临床症状分析[J].中国妇幼保健,2017,32(14):3177-3179.
[2] 孙馥箐,段华.子宫内膜异位症不孕患者子宫内膜病变特征分析[J].中国计划生育和妇产科,2016,8(7):49-53.
[3] Vercellini P,Crosignani P G,Abbiati A,et al.The effect of surgery for symptomatic endometriosis:the other side of the story[J].Hum Reprod Update,2016,15(2):177-188.
[4] 王化丽,路云晖.子宫内膜异位症保守性手术后药物治疗进展[J].中国医师进修杂志,2016,39(7):577-580.
[5] 江成龙,张昌军.增加长效GnRH-a垂体降调节时间及剂量对改善IVF-ET结局的临床研究[J].中国计划生育学杂志,2016,24(6):391-394.
[6] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[7] 里兹克.不孕症与辅助生殖[M].北京:人民卫生出版社,2013:36-39.
[8] 吴能秀,谢熙,刘超斌,等.宫腹腔镜手术治疗Ⅲ-Ⅳ期子宫内膜异位症合并不孕症的疗效观察[J].中国计划生育学杂志,2016,24(5):334-336.
[9] Legendre G,Catala L,Morinière C,et al.Relationship between ovarian cysts and infertility:what surgery and when?[J].Fertil Steril,2014,101(3):608-614.
[10] Kent A,Shakir F,Rockall T,et al.Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel:A Prospective Cohort Study[J].Journal of Minimally Invasive Gynecology,2016,23(4):526-534.
[11] 杨春丽,潘瓷,杨敬敬.GnRH-a退缩疗法及常规疗法对不同体重子宫内膜异位症保守性手术后患者的疗效比较[J].广东医学,2016,37(4):616-620.
[12] 朱晗璐,何晔,吴欢,等.GnRH-a预处理对子宫内膜异位症患者冻融胚胎移植结局的影响[J].安徽医科大学学报,2016,51(9):1303-1307.
[13] 周明,陈丹丹,王丽娜,等.腹腔镜联合GnRH-a治疗Ⅰ期子宫内膜异位症不孕的临床研究[J].腹腔镜外科杂志,2016,21(12):948-950.
[14] 詹润芳.GnRH-a联合腹腔镜保守性手术治疗Ⅲ～Ⅳ期子宫内膜异位症的疗效及复发因素分析[J].医学临床研究,2016,33(2):238-241.
[15] 张黎,吴忠新.GnRH-a联合雌孕激素反向添加疗法治疗重度子宫内膜异位症患者疼痛及远期复发率随访[J].临床和实验医学杂志,2017,16(13):1325-1327.
[16] 王秀芬,林小娜,戴永东,等.子宫内膜异位症患者卵泡液、卵泡刺激素骨形态发生蛋白-15对颗粒细胞增殖及孕酮分泌的影响[J].中华医学杂志,2017,97(45):3543-3547.
[17] 赵磐琳,童英,庞春元.助孕时机对子宫内膜异位症不孕患者术后妊娠率的影响[J].中国计划生育学杂志,2016,24(8):537-540.
[2] 孙馥箐,段华.子宫内膜异位症不孕患者子宫内膜病变特征分析[J].中国计划生育和妇产科,2016,8(7):49-53.
[3] Vercellini P,Crosignani P G,Abbiati A,et al.The effect of surgery for symptomatic endometriosis:the other side of the story[J].Hum Reprod Update,2016,15(2):177-188.
[4] 王化丽,路云晖.子宫内膜异位症保守性手术后药物治疗进展[J].中国医师进修杂志,2016,39(7):577-580.
[5] 江成龙,张昌军.增加长效GnRH-a垂体降调节时间及剂量对改善IVF-ET结局的临床研究[J].中国计划生育学杂志,2016,24(6):391-394.
[6] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[7] 里兹克.不孕症与辅助生殖[M].北京:人民卫生出版社,2013:36-39.
[8] 吴能秀,谢熙,刘超斌,等.宫腹腔镜手术治疗Ⅲ-Ⅳ期子宫内膜异位症合并不孕症的疗效观察[J].中国计划生育学杂志,2016,24(5):334-336.
[9] Legendre G,Catala L,Morinière C,et al.Relationship between ovarian cysts and infertility:what surgery and when?[J].Fertil Steril,2014,101(3):608-614.
[10] Kent A,Shakir F,Rockall T,et al.Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel:A Prospective Cohort Study[J].Journal of Minimally Invasive Gynecology,2016,23(4):526-534.
[11] 杨春丽,潘瓷,杨敬敬.GnRH-a退缩疗法及常规疗法对不同体重子宫内膜异位症保守性手术后患者的疗效比较[J].广东医学,2016,37(4):616-620.
[12] 朱晗璐,何晔,吴欢,等.GnRH-a预处理对子宫内膜异位症患者冻融胚胎移植结局的影响[J].安徽医科大学学报,2016,51(9):1303-1307.
[13] 周明,陈丹丹,王丽娜,等.腹腔镜联合GnRH-a治疗Ⅰ期子宫内膜异位症不孕的临床研究[J].腹腔镜外科杂志,2016,21(12):948-950.
[14] 詹润芳.GnRH-a联合腹腔镜保守性手术治疗Ⅲ～Ⅳ期子宫内膜异位症的疗效及复发因素分析[J].医学临床研究,2016,33(2):238-241.
[15] 张黎,吴忠新.GnRH-a联合雌孕激素反向添加疗法治疗重度子宫内膜异位症患者疼痛及远期复发率随访[J].临床和实验医学杂志,2017,16(13):1325-1327.
[16] 王秀芬,林小娜,戴永东,等.子宫内膜异位症患者卵泡液、卵泡刺激素骨形态发生蛋白-15对颗粒细胞增殖及孕酮分泌的影响[J].中华医学杂志,2017,97(45):3543-3547.
[17] 赵磐琳,童英,庞春元.助孕时机对子宫内膜异位症不孕患者术后妊娠率的影响[J].中国计划生育学杂志,2016,24(8):537-540.