结直肠子宫内膜异位症与生育能力

Colorectal endometriosis and fertility.

作者信息

Daraï Emile, Cohen Jonathan, Ballester Marcos

机构信息

Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:86-94. doi: 10.1016/j.ejogrb.2016.05.024. Epub 2016 Jun 9.

DOI:10.1016/j.ejogrb.2016.05.024

PMID:27342685

Abstract

OBJECTIVE

The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.

STUDY DESIGN

MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: "deep endometriosis", "deep infiltrating endometriosis", "bowel endometriosis", "colorectal endometriosis", "fertility", "infertility", "IVF-ICSI", "Assisted Reproductive Techniques (ART)", and "MAR".

RESULTS

Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI=14-39). PR after MAR was 27.4% (95% CI=19-35) and the overall PR was 37.9% (95% CI=29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI=28-34) without difference between the groups. PR after MAR was 19.8% (95% CI=17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI=18-25) and 15.5% (95% CI=11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI=48-54).

CONCLUSION

Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

摘要

目的

本综述的目的是评估结直肠子宫内膜异位症对自然生育能力的影响，以及医学辅助生殖（MAR）（体外受精和宫内人工授精）和手术对生育结局的潜在益处。

研究设计

利用以下检索词在MEDLINE数据库中检索1990年至2015年12月期间发表的关于深部浸润型子宫内膜异位症（DIE）女性生育情况的文章：“深部子宫内膜异位症”、“深部浸润性子宫内膜异位症”、“肠道子宫内膜异位症”、“结直肠子宫内膜异位症”、“生育力”、“不孕”、“IVF-ICSI”、“辅助生殖技术（ART）”和“MAR”。

结果

接受DIE切除术但保留原位结直肠子宫内膜异位症的患者自然妊娠率（PR）为26.5%（95%CI=14-39）。MAR后的PR为27.4%（95%CI=19-35），总体PR为37.9%（95%CI=29-37）。结直肠手术后，在855例有或无不孕证据的患者中，自然PR为31.4%（95%CI=28-34），两组之间无差异。MAR后的PR为19.8%（95%CI=17-22）。有和无不孕证据的患者MAR后的PR分别为21.4%（95%CI=18-25）和15.5%（95%CI=11-20）。结直肠手术后的总体PR为51.1%（95%CI=48-54）。