Yeung Patrick P, Su Melody S, Voltz John, Gavard Jeffrey A
Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO, United States.
Saint Louis University School of Medicine, St. Louis, MO, United States.
Front Reprod Health. 2023 Nov 22;5:1231029. doi: 10.3389/frph.2023.1231029. eCollection 2023.
Pregnancy rates after the placement of expanded polytetrafluoroethylene (ePTFE, trade name Gore-Tex®) for adhesion prevention following cystectomy of endometriomas ≥3 cm and excision of endometriosis were analyzed in this pilot study.
A prospective cohort study was performed at a single tertiary care center. 56 women qualified for the study and underwent surgery. Expanded polytetrafluoroethylene placement around affected ovaries was self-selected. Inclusion criteria for analysis were pathology-confirmed endometrioma ≥3 cm, no hysterectomy at time of surgery, ≥1 year of postoperative survey completion, and absence of strategies to avoid pregnancy. 18 women in the ePTFE group and 11 women in the control group met inclusion criteria for analysis. 16 of the 18 women in the ePTFE group and 7 of the 11 women in the control group were affected by infertility. Absolute pregnancy rates and cumulative 4-year pregnancy rates, which are based on survival analysis using lifetables and adjust for varying follow-up times, were calculated for all women as well as for women with infertility only.
High cumulative 4-year pregnancy rates were observed for women with expanded polytetrafluoroethylene compared to women without (85% vs. 65%, p = 0.69). High cumulative 4-year pregnancy rates for women with infertility prior to surgery were observed for women with expanded polytetrafluoroethylene compared to women without (83% vs. 33%, p = 0.89).
There are consistent trends, although not statistically significant, seen in pregnancy rates for women with ePTFE compared to women without, particularly in those with a history of infertility prior to ePTFE use. This is the first study examining how adhesion prevention strategy targeting the adnexa during surgery for endometriosis affects pregnancy rates. The trend towards increased pregnancy rates with expanded polytetrafluoroethylene use, particularly in patients with a history of infertility, is promising and warrants further study with larger groups.
在这项前瞻性研究中，分析了在子宫内膜异位囊肿切除术和子宫内膜异位症切除术后放置膨体聚四氟乙烯（ePTFE，商品名Gore-Tex®）预防粘连后的妊娠率。
在一家三级医疗中心进行了一项前瞻性队列研究。56名符合研究条件的女性接受了手术。是否在受影响的卵巢周围放置膨体聚四氟乙烯由患者自行选择。分析的纳入标准为病理确诊的子宫内膜异位囊肿≥3 cm、手术时未行子宫切除术、术后随访完成≥1年以及未采取避孕措施。ePTFE组18名女性和对照组11名女性符合分析纳入标准。ePTFE组18名女性中的16名以及对照组11名女性中的7名患有不孕症。计算了所有女性以及仅患有不孕症女性的绝对妊娠率和基于生命表生存分析并针对不同随访时间进行调整的4年累积妊娠率。
与未使用膨体聚四氟乙烯的女性相比，使用膨体聚四氟乙烯的女性观察到较高 的4年累积妊娠率（85%对65%，P = 0.69）。与未使用膨体聚四氟乙烯的女性相比，术前患有不孕症的女性使用膨体聚四氟乙烯观察到较高的4年累积妊娠率（83%对33%，P = 0.89）。
与未使用膨体聚四氟乙烯的女性相比，使用膨体聚四氟乙烯的女性在妊娠率方面存在一致的趋势，尽管无统计学意义，尤其是在使用膨体聚四氟乙烯之前有不孕症病史的女性中。这是第一项研究手术治疗子宫内膜异位症期间针对附件的粘连预防策略如何影响妊娠率 的研究。使用膨体聚四氟乙烯后妊娠率增加的趋势，特别是在有不孕症病史的患者中，是有前景的，值得在更大规模的人群中进一步研究。
