Saravelos H G, Li T C, Cooke I D
Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, UK.
Hum Reprod. 1995 Nov;10(11):2887-94. doi: 10.1093/oxfordjournals.humrep.a135813.
We evaluated 81 women with adnexal adhesions and no male factor who underwent microsurgical (n = 59) and laparoscopic (n = 22) adhesiolysis for infertility. The cumulative conception rates for all 81 patients at 12 and 24 months were 41 and 44% respectively. The impact of the following variables on cumulative conception rates for all patients was examined: age, duration of infertility, type of infertility, ovulatory status, presence and stage of endometriosis, adhesion grade, adnexal status (bilateral or unilateral disease, unilateral tubal absence), history of previous surgery, history of pelvic inflammatory disease and treatment modality (microsurgical versus laparoscopic). The results of independent comparisons of subgroups within each of these variables may be biased because of the interrelationships between the variables. To overcome this problem, a stepwise Cox's proportional hazards regression analysis was employed. Our analysis showed that the single most significant variable influencing the cumulative conception rates was the duration of infertility (P < 0.005). For every additional year of infertility, the probability of pregnancy after adhesiolysis (microsurgical or laparoscopic) was reduced by approximately 20%. Cumulative conception rates at 12 and 24 months after microsurgical adhesiolysis were 36 and 40% respectively, while after laparoscopic adhesiolysis they were 57% at 12 and 24 months. When imbalances were adjusted between the two treatment groups, there was no statistically significant difference between the cumulative conception rates for microsurgical and laparoscopic adhesiolysis.
我们评估了81名患有附件粘连且无男方因素的女性，她们因不孕症接受了显微手术（n = 59）和腹腔镜粘连松解术（n = 22）。81名患者在12个月和24个月时的累积妊娠率分别为41%和44%。研究了以下变量对所有患者累积妊娠率的影响：年龄、不孕持续时间、不孕类型、排卵状态、子宫内膜异位症的存在及分期、粘连分级、附件状态（双侧或单侧疾病、单侧输卵管缺失）、既往手术史、盆腔炎病史及治疗方式（显微手术与腹腔镜手术）。由于这些变量之间的相互关系，每个变量内亚组的独立比较结果可能存在偏差。为克服这一问题，采用了逐步Cox比例风险回归分析。我们的分析表明，影响累积妊娠率的最显著单一变量是不孕持续时间（P < 0.005）。不孕时间每增加一年，粘连松解术后（显微手术或腹腔镜手术）的妊娠概率约降低20%。显微手术粘连松解术后12个月和24个月的累积妊娠率分别为36%和40%，而腹腔镜粘连松解术后12个月和24个月的累积妊娠率均为57%。当对两个治疗组之间的不均衡进行调整后，显微手术和腹腔镜粘连松解术的累积妊娠率之间无统计学显著差异。
