腹腔镜结直肠切除术治疗子宫内膜异位症后的生育结局决定因素。
Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis.
机构信息
Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris 6, 4 rue de la Chine, 75020 Paris, France.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2010 Apr;149(2):210-4. doi: 10.1016/j.ejogrb.2009.12.032. Epub 2010 Jan 21.
OBJECTIVE
The aims of this prospective study were to evaluate fertility, pregnancy outcomes and their determinant factors after laparoscopic segmental colorectal resection for endometriosis.
STUDY DESIGN
We studied 83 women who underwent colorectal resection for endometriosis. Thirty-nine women (47%) had an associated infertility and 51 (61.4%) wished to conceive after surgery. Surgical route was exclusive laparoscopy in 77 cases (92.7%) and laparoconversion in 6 (7.3%).
RESULTS
Twenty-nine pregnancies were obtained in 24 patients (43.6%) including 20 spontaneous (69%) and 9 by IVF (31%). The median time to conceive spontaneously was 6 months and 20 months by IVF. Among the 39 infertile women, 18 (46%) conceived during the study period. A relation was found between pregnancy rate and patient age (p=0.02). Reduction in pregnancy rate was correlated to the presence of adenomyosis (p=0.04) and high ASRM total score (p<0.001) as well as exclusive laparoscopy compared to conversion to laparotomy for colorectal resection (p=0.01).
CONCLUSION
Adenomyosis and conversion to laparotomy as well as patient age, ASRM score appeared determinant factors of fertility outcome.
目的
本前瞻性研究旨在评估子宫内膜异位症腹腔镜结肠部分切除术的生育能力、妊娠结局及其决定因素。
研究设计
我们研究了 83 名因子宫内膜异位症接受结肠切除术的女性。39 名女性（47%）存在相关不孕问题，51 名（61.4%）希望手术后怀孕。77 例（92.7%）采用单纯腹腔镜手术，6 例（7.3%）采用腹腔镜中转开腹手术。
结果
24 名患者中有 29 例妊娠（43.6%），包括 20 例自然妊娠（69%）和 9 例 IVF 妊娠（31%）。自然妊娠的中位时间为 6 个月，IVF 妊娠的中位时间为 20 个月。39 名不孕妇女中，18 名（46%）在研究期间怀孕。妊娠率与患者年龄呈正相关（p=0.02）。妊娠率降低与腺肌病（p=0.04）和 ASRM 总评分高（p<0.001）有关，与腹腔镜中转开腹相比（p=0.01），与单纯腹腔镜手术相比，行结肠切除术时妊娠率降低。
结论
腺肌病、中转开腹以及患者年龄、ASRM 评分是生育结局的决定因素。
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