el Amrani R, Henry-Suchet J, Cornier E, Sarjdine K, Mayenga J M, Loysel T, Belaisch-Allart J
Service de gynécologie-obstétrique et reproduction humaine, hôpital Jean-Rostand, 141, Grande Rue, 92311, Sèvres, France.
Gynecol Obstet Fertil. 2001 Mar;29(3):192-9. doi: 10.1016/s1297-9589(00)00074-6.
Define the best medico surgical strategy in infertile women with stage III-IV endometriosis.
Two groups, A (N26) and B (N 37), treated for infertility associated or not with pelvic pain, due to stage AFS III or IV endometriosis, were compared. They had similar surgical procedure: operative laparoscopy including resection of endometriotic lesions, more particularly endometriomas and rectovaginal septum nodules. Associated medical strategy was different: group A, operative laparoscopy without preoperative treatment and in 40% a second laparoscopy taking place after 2-3 months of LHRH analogues; no post operative treatment; group B, operative laparoscopy taking place after ovarian blockage with 3-6 weeks of Diane (Androcur + ethinyl estradiol), then 2-3 months of analogue postoperative treatment immediately followed by ovarian stimulation (OS) + intrauterine insemination (IUI) in women more than 30 years old with operative tubes (N 22), no treatment for six months in similar cases less than 30 (N 5), and IVF in women with damaged tubes (N 5) or after OS + IUI failure (N 4). One patient refused two patients with high FSH level had oocyte donation.
Two years evolutive pregnancy rate was significantly higher (p < 0.01) in group B (59%) versus group A (23%) and was higher after OS + IUI (68%) than after IVF (55%) or without any treatment in women < 30 (43%). The difference is equally significant by age (p < 0.05), for endometriomas (p < 0.01) and for recurrences (p < 0.01).
Similar results obtained for pelvic pain (see chapter I) suggest that both strategies are similarly successful in treating endometriosis. These results confirm the interest of an ART after surgery for stage III-IV endometriosis and show that OS + IUI, a less costly than IVF technique, can be used successfully in selected cases with operative tubes.
确定患有III-IV期子宫内膜异位症的不孕女性的最佳药物手术治疗策略。
比较了A组（N = 26）和B组（N = 37），两组均因AFS III期或IV期子宫内膜异位症接受与盆腔疼痛相关或无关的不孕症治疗。两组手术方式相似：均为手术腹腔镜检查，包括切除子宫内膜异位病变，尤其是卵巢巧克力囊肿和直肠阴道隔结节。相关的药物治疗策略不同：A组，术前未进行治疗直接进行手术腹腔镜检查，40%的患者在使用促性腺激素释放激素（LHRH）类似物2-3个月后进行第二次腹腔镜检查；术后未进行治疗；B组，在使用3-6周的达英（环丙孕酮+炔雌醇）进行卵巢阻断后进行手术腹腔镜检查，术后立即进行2-3个月的类似物治疗，随后对30岁以上输卵管通畅的女性（N = 22）进行卵巢刺激（OS）+宫内人工授精（IUI），30岁以下情况类似的女性（N = 5）6个月不进行治疗，输卵管受损的女性（N = 5）或OS + IUI失败后（N = 4）进行体外受精（IVF）。1例患者拒绝治疗，2例促卵泡生成素（FSH）水平高的患者接受了卵母细胞捐赠。
B组（59%）的两年累积妊娠率显著高于A组（23%）（p < 0.01），且OS + IUI后的妊娠率（68%）高于IVF后的妊娠率（55%）或30岁以下未进行任何治疗女性的妊娠率（43%）。按年龄（p < 0.05）、卵巢巧克力囊肿（p < 0.01）和复发情况（p < 0.01）划分，差异同样显著。
盆腔疼痛方面获得的相似结果（见第一章）表明，两种治疗策略在治疗子宫内膜异位症方面同样成功。这些结果证实了对III-IV期子宫内膜异位症患者术后进行辅助生殖技术（ART）的益处，并表明OS + IUI作为一种成本低于IVF的技术，可在选定的输卵管通畅病例中成功应用。
