Bourdel N, Dejou-Bouillet L, Roman H, Jaffeux P, Aublet-Cuvelier B, Mage G, Pouly J-L, Canis M
Pôle de gynécologie-obstétrique, CHU Estaing Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
Gynecol Obstet Fertil. 2012 Jun;40(6):337-43. doi: 10.1016/j.gyobfe.2011.07.037. Epub 2011 Oct 22.
To evaluate in infertile women the benefit of laparoscopic surgical treatment of endometriosis.
All infertile patients aged 18 to 43 years old, operated between February 2004 and March 2008, with a minimal follow-up of 18 months, coming from the Auvergne cohort of endometriosis has been, were included. The primary end point was the achievement of a pregnancy.
One hundred and twenty-three patients have been included. Global pregnancy rate was 48%, which 47% was spontaneous with a mean postoperative delay of 6±4.5 months. Sixty-three patients had benefited from Assisted Reproductive Technology (ART) and 25 pregnancies were obtained (pregnancy rate: 39.7% with a mean delay of 10±3.8 months). Eighty-one percent of spontaneous pregnancies were obtained during the first 12 postoperative months. Duration of preoperative infertility and tubal involvement were significantly associated with lower spontaneous pregnancy rate. No significant differences were found between endometriosis stage I and II compared to stage III and IV, and between patient under 34 years old compared to older.
With this first study on infertility from the Auvergne cohort of endometriosis, we are confirmed that surgery is one of the central issues in the treatment of infertile endometriosis patient. The postoperative delay to obtain a spontaneous pregnancy requires a quick management by ART after 6 to 12 postoperative month and an immediate management by ART in case of tubal involvement or former infertility.
评估腹腔镜手术治疗子宫内膜异位症对不孕女性的益处。
纳入2004年2月至2008年3月间手术、年龄在18至43岁之间、随访至少18个月、来自奥弗涅子宫内膜异位症队列的所有不孕患者。主要终点是实现妊娠。
共纳入123例患者。总体妊娠率为48%，其中47%为自然妊娠，术后平均延迟时间为6±4.5个月。63例患者接受了辅助生殖技术（ART）治疗，获得25次妊娠（妊娠率：39.7%，平均延迟时间为10±3.8个月）。81%的自然妊娠发生在术后前12个月内。术前不孕持续时间和输卵管受累与较低的自然妊娠率显著相关。与III期和IV期相比，I期和II期子宫内膜异位症患者之间以及34岁以下患者与年龄较大患者之间未发现显著差异。
通过对奥弗涅子宫内膜异位症队列中不孕患者的首次研究，我们证实手术是治疗不孕子宫内膜异位症患者的核心问题之一。术后获得自然妊娠的延迟时间要求在术后6至12个月后通过ART进行快速处理，而在输卵管受累或既往不孕的情况下则立即通过ART进行处理。
