Monti B, Varisco E, Cortese M, Calienno C, Iedà N
Clinica Ostetrica e Ginecologica, Istituto di Scienze Biomediche San Gerardo, Via Solferino 16, 20052 Monza, Milan, Italy.
Minerva Ginecol. 2007 Feb;59(1):27-34.
The aim of this paper was to assess the impact on fertility of surgery to eradicate endometriosis.
One-hundred and twenty-six patients aged between 20 and 40 were observed. All wished to have offspring after the operation and were subjected to conservative surgery for stage III and IV endometriosis (rAFS score > 16) in the period 1992-2002. The type of surgical approach was chosen in consideration of the patient's clinical condition and on the basis of the experience of the surgeon, with the aim of radically removing the disease and, where necessary, restoring fertility.
Fifty-six of 126 patients (44.4%) conceived after the operation; 55 spontaneously and 1 with assisted fecundation. Of the patients observed who became pregnant, about 1/3 (32%) conceived within 6 months of the operation and 1/3 (31%) after 12 months. Forty-four (78.5%) pregnancies reached term with a positive outcome, 7 (12.5%) were in progress at the moment of follow-up, 4 (7.1%) suffered a miscarriage and 1 (1.7%) was extrauterine; 48.2% (27/56 patients) of the pregnancies were stage III, 40% (28/70 patients) were stage IV.
It emerges clearly from the data extrapolated from our series that surgery to eradicate endometriosis increases the fertility of the patients affected, without being resolutive: more than half the patients in fact remained sterile in spite of the operation.
本文旨在评估根除子宫内膜异位症的手术对生育能力的影响。
观察了126例年龄在20至40岁之间的患者。所有患者术后都希望生育，并于1992年至2002年期间接受了针对III期和IV期子宫内膜异位症（rAFS评分>16）的保守手术。手术方式根据患者的临床状况并基于外科医生的经验来选择，目的是彻底清除疾病，并在必要时恢复生育能力。
126例患者中有56例（44.4%）术后受孕；55例自然受孕，1例通过辅助生殖受孕。在观察到的受孕患者中，约三分之一（32%）在术后6个月内受孕，三分之一（31%）在12个月后受孕。44例（78.5%）妊娠足月且结局良好，7例（12.5%）在随访时仍在进行中，4例（7.1%）流产，1例（1.7%）为宫外孕；妊娠患者中48.2%（27/56例）为III期，40%（28/70例）为IV期。
从我们系列研究推断的数据中可以清楚地看出，根除子宫内膜异位症的手术可提高受影响患者的生育能力，但并非决定性的：事实上，超过一半的患者尽管接受了手术仍未生育。
