Lin Jin-fang, Sun Cui-xiang, Hua Ke-qin, Xue Xiao-hong, Li Yang
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Zhonghua Fu Chan Ke Za Zhi. 2005 Jan;40(1):9-12.
To investigate the role of laparoscopy in diagnosis and treatment of infertile women with endometriosis.
Totally 314 infertile cases were diagnosed as having endometriosis by laparoscopy, and 58, 173, 68 and 15 cases were assigned to stage I, II, III and IV groups respectively according to the revised classification American Fertility Society (r-AFS). Laparoscopic treatment included excision of ovarian endometriosis lesions, lysis of adhesions, endocoagulation of pelvic endometriosis lesions with controlled heating (100 degrees C) and lavaging of the peritoneal cavity. The duration of follow-up after laparoscopic surgery was censored at 36 weeks. Women who became pregnant were followed up to 20 weeks' gestation. The U and chi(2) tests were used to determine significance of difference in the rate of pregnancy and spontaneous abortion between all clinical stages.
Of all the 314 cases, 254 became pregnant within 36 weeks after surgery. The cumulative numbers of pregnancy were 50 (86.2%, 50/58), 141 (81.5%, 141/173), 52 (76.5%, 52/68) and 11 (73.3%, 11/15) in stage I-IV groups respectively. The accumulative pregnancy rates were, however, not significantly different among stages I-IV (P > 0.05). The accumulative pregnancy rate within 24 weeks after surgery (93.7%, 238/254) was higher than that within 25 - 36 weeks after surgery (6.3%, 16/254). Of 254 cases who were pregnant, 12 had miscarriage. There was no significant difference of miscarriage rate between all stages (P > 0.05). While the rate of miscarriage was higher within 12 weeks of gestation (83.3%, 10/12) than that of after 12 weeks of gestation (P < 0.05).
Early lesions of endometriosis and pelvic factors for infertility can be found by laparoscopy. And pregnancy rate of endometriosis-associated infertility can be improved by laparoscopic surgery. To clean the menstrual blood pool and ablate peritoneal lesion with endocoagulation as completely as possible have significant importance for enhancement of fecundity in infertile women with endometriosis, especially for stage I-II cases.
探讨腹腔镜检查在子宫内膜异位症所致不孕妇女诊断及治疗中的作用。
314例不孕患者经腹腔镜检查诊断为子宫内膜异位症，根据美国生育协会修订分类法（r-AFS），分别将58、173、68及15例患者归入Ⅰ、Ⅱ、Ⅲ及Ⅳ期组。腹腔镜治疗包括切除卵巢子宫内膜异位症病灶、松解粘连、对盆腔子宫内膜异位症病灶进行可控加热（100℃）的内膜凝固术及冲洗腹腔。腹腔镜手术后的随访时间截止至36周。妊娠的妇女随访至妊娠20周。采用U检验和卡方检验确定各临床分期妊娠率和自然流产率差异的显著性。
314例患者中，254例在术后36周内妊娠。Ⅰ-Ⅳ期组妊娠累积数分别为50例（86.2%，50/58）、141例（81.5%，141/173）、52例（76.5%，52/68）及11例（73.3%，11/15）。然而，Ⅰ-Ⅳ期组的累积妊娠率差异无显著性（P>0.05）。术后24周内的累积妊娠率（93.7%，238/254）高于术后25-36周内的累积妊娠率（6.3%，16/254）。254例妊娠患者中，12例发生流产。各期流产率差异无显著性（P>0.05）。妊娠12周内的流产率（83.3%，10/12）高于妊娠12周后的流产率（P<0.05）。
腹腔镜检查可发现子宫内膜异位症早期病变及不孕的盆腔因素。腹腔镜手术可提高子宫内膜异位症相关性不孕的妊娠率。彻底清除经血池并尽可能完全地用内膜凝固术消融腹膜病灶对于提高子宫内膜异位症不孕妇女的生育力具有重要意义，尤其是对于Ⅰ-Ⅱ期病例。
Zotero 插件