Napolitano C, Marziani R, Mossa B, Perniola L, Benagiano G
First Institute of Gynaecology and Obstetrics, University La Sapienza, Rome, Italy.
Eur J Obstet Gynecol Reprod Biol. 1994 Mar 15;53(3):199-204. doi: 10.1016/0028-2243(94)90119-8.
A retrospective analysis is reported of the management of 117 cases of infertility associated with Stage III and IV endometriosis. Combined medico-microsurgical treatment was selected in 75.3% of Stage III cases and in 83.3% of those on Stage IV. Medication consisted of medroxyprogesterone acetate in 26 patients and danazol in the remaining 64. Microsurgery alone was utilized in 24.7% of Stage III patients and in 16.6% of those on Stage IV. Both surgery alone and the combined therapy had a profound positive effect on subjective symptoms: dysmenorrhea, dyspareunia and pelvic pain. Following combined therapy, pregnancy was achieved in 34.4% of all women. Respective figures are 30.7% for medroxyprogesterone acetate (29.4% Stage III and 33.3% Stage IV) and 35.9% for danazol (37.7% Stage III and 27.2% Stage IV). In the group of patients treated by surgery alone, pregnancy occurred in 25.9%. Of the pregnancies in women with Stage III endometriosis, 25 were carried to term and 6 ended with a spontaneous abortion; figures for Stage IV women are 5 and 2, respectively. Second-look laparoscopy was performed in 49 of the 79 patients who failed to conceive, at 12-36 months after treatment; persistent genital pathology, to which infertility could be attributed, was found in 77.5% of them.
本文报道了对117例III期和IV期子宫内膜异位症相关性不孕病例的治疗回顾性分析。III期病例中75.3%以及IV期病例中83.3%选择了药物与显微手术联合治疗。26例患者使用醋酸甲羟孕酮，其余64例使用达那唑。III期患者中24.7%以及IV期患者中16.6%仅采用显微手术治疗。单纯手术治疗和联合治疗对主观症状（痛经、性交困难和盆腔疼痛）均有显著的积极影响。联合治疗后，所有女性中有34.4%成功妊娠。醋酸甲羟孕酮组和达那唑组的相应妊娠率分别为30.7%（III期为29.4%，IV期为33.3%）和35.9%（III期为37.7%，IV期为27.2%）。单纯手术治疗组的妊娠率为25.9%。III期子宫内膜异位症女性的妊娠中，25例足月分娩，6例自然流产；IV期女性的相应数字分别为5例和2例。79例未受孕患者中有49例在治疗后12 - 36个月进行了二次腹腔镜检查，其中77.5%发现了可导致不孕的持续性生殖器病变。
