Porpora Maria Grazia, Tomao Federica, Manganaro Lucia, Yazdanian Deliar, Fuggetta Eliana, Piccioni Maria Grazia, Benedetti Panici Pierluigi, Benagiano Giuseppe
Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena 324, Rome 00161, Italy.
J Ovarian Res. 2014 Jan 8;7:1. doi: 10.1186/1757-2215-7-1.
Aim of this prospective, case-control study was to evaluate uterine arteries' blood flow before and after laparoscopic surgery in patients with ovarian endometriosis and its possible correlation with infertility.
We prospectively enrolled 110 women of reproductive age; 69 with ovarian endometriomas and scheduled for surgery, and 41 controls. At enrolment, a detailed medical, gynecologic and obstetric history was collected. Fertility and pregnancy desire were assessed. All patients underwent complete physical and gynecologic examination. Transvaginal ultrasound with Doppler color flow was performed to evaluate Resistance Index (RI) of uterine arteries during the secretory phase, at enrolment (T0) and 3 months after laparoscopic surgery (T1).
Among cases, 27 patients were excluded because they did not meet the inclusion criteria. At enrolment (T0) unilateral or bilateral flow alterations (RI ≥ 0.8) were found in 38 out of 42 patients with ovarian endometriosis (90%), whereas in the control group only 17 women (41%) had Doppler alterations. The difference in uterine artery RI values between cases and controls was statistically significant (P < 0.0001). A statistically significant improvement in uterine artery flow (P <0.0001) was found 3 months after surgical treatment of endometriosis. Nineteen patients with endometriosis (45%) were infertile before surgery; all of them presented uterine artery Doppler alterations at T0. After surgery the pregnancy rate was significantly higher in patients who presented uterine artery flow normalization than in those with persistent uterine artery flow alterations (p = 0.002).
A strong correlation was found between uterine artery flow abnormalities and ovarian endometriosis. Uterine artery flow improvement following surgery seems to increase the probabilities of achieving pregnancy.
本前瞻性病例对照研究的目的是评估卵巢子宫内膜异位症患者腹腔镜手术前后子宫动脉的血流情况及其与不孕的可能相关性。
我们前瞻性纳入了110名育龄女性；69例患有卵巢子宫内膜异位囊肿并计划进行手术，41例为对照组。入组时，收集详细的内科、妇科和产科病史。评估生育能力和妊娠意愿。所有患者均接受全面的体格和妇科检查。在入组时（T0）及腹腔镜手术后3个月（T1）的分泌期，采用经阴道超声结合彩色多普勒血流成像评估子宫动脉的阻力指数（RI）。
在病例组中，27例患者因不符合纳入标准而被排除。入组时（T0），42例卵巢子宫内膜异位症患者中有38例（90%）出现单侧或双侧血流改变（RI≥0.8），而对照组中只有17名女性（41%）有多普勒改变。病例组和对照组子宫动脉RI值的差异具有统计学意义（P<0.0001）。子宫内膜异位症手术治疗3个月后，子宫动脉血流有统计学意义的改善（P<0.0001）。19例子宫内膜异位症患者（45%）术前不孕；她们在T0时均出现子宫动脉多普勒改变。手术后，子宫动脉血流恢复正常的患者妊娠率明显高于子宫动脉血流持续改变的患者（p=0.002）。
子宫动脉血流异常与卵巢子宫内膜异位症之间存在密切相关性。手术后子宫动脉血流的改善似乎增加了妊娠的可能性。
