Fujishita Akira, Khan Khaleque Newaz, Masuzaki Hideaki, Ishimaru Tadayuki
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan.
Gynecol Obstet Invest. 2002;53 Suppl 1:40-5. doi: 10.1159/000049423.
We investigated the influence of pelvic endometriosis and ovarian endometrioma on pregnancy outcome in women associated with infertility. A total of 237 women with endometriosis were reviewed, and their fertility rate was assessed by both r-AFS staging and TOP classification as previously proposed by our group. There was no significant difference in pregnancy rate among r-AFS stages. However, the pregnancy rate was mostly affected by the tubal condition according to the TOP classification as follows: no adhesive lesion (T0), 53% (69/129); unilateral lesion (T1), 46% (18/39); bilateral lesion with at least one tube patent, (T2), 37% (10/27); bilateral tubal occlusion (T3), 0% (0/8) (p < 0.05, Mantel-Extension test). The absence (O0-O1) or co-existence (O2-O3) of ovarian endometrioma and different gradings of cul-de-sac obliteration (P2-P3) showed no significant differences in pregnancy rate. The resulting conception rate was also not affected by the size or location of ovarian endometrioma. In addition, the higher adhesion score of ovarian endometrioma involving the fallopian tube and as described in r-AFS classification had a significant detrimental effect on fertility. These observations suggest that our TOP classification describing individual tubal condition has a clinically predictive value in assessing the reproductive outcome of women with endometriosis.
我们研究了盆腔子宫内膜异位症和卵巢子宫内膜异位囊肿对不孕女性妊娠结局的影响。共回顾了237例子宫内膜异位症女性患者，并按照我们团队之前提出的r-AFS分期和TOP分类法评估她们的受孕率。r-AFS各期之间的妊娠率无显著差异。然而，根据TOP分类法，妊娠率主要受输卵管状况的影响，具体如下：无粘连病变（T0），53%（69/129）；单侧病变（T1），46%（18/39）；双侧病变且至少一侧输卵管通畅（T2），37%（10/27）；双侧输卵管阻塞（T3），0%（0/8）（p<0.05，Mantel-Extension检验）。卵巢子宫内膜异位囊肿的不存在（O0-O1）或并存（O2-O3）以及不同程度的直肠子宫陷凹闭塞（P2-P3）在妊娠率方面均无显著差异。最终的受孕率也不受卵巢子宫内膜异位囊肿大小或位置的影响。此外，如r-AFS分类中所述，累及输卵管的卵巢子宫内膜异位囊肿粘连评分越高，对生育能力的不利影响越显著。这些观察结果表明，我们描述个体输卵管状况的TOP分类法在评估子宫内膜异位症女性的生殖结局方面具有临床预测价值。
