子宫内膜异位症合并不孕术后妊娠影响因素及其预测价值

发布时间：2018-05-08 23:42

  本文选题：子宫内膜异位症 + 不孕　； 参考：《浙江大学》2015年硕士论文

【摘要】：目的 探究子宫内膜异位症合并不孕患者行腹腔镜治疗术后影响妊娠的因素及其预测术后妊娠结局的价值,为临床治疗提供科学依据。 方法 收集、整理、随访本院2011年4月至2013年12月行腹腔镜手术治疗的子宫内膜异位症(EMT)合并不孕患者的病史、手术资料、手术后治疗情况及妊娠结局。回顾性分析患者的年龄、r-AFS分期,EFI评分、窦卵泡数、术后GnRH-a治疗与否、术后ART治疗与否等因素与EMT合并不孕患者术后妊娠的关系。采用SPSS19.0统计软件数据包进行分析。 结果 1.2011年4月至2013年12月共489例患者接受手术,失访57例,随访到病例432例。术后随访12-36个月。术后成功妊娠290例(其中自然妊娠143例,IVF妊娠138例,人工授精妊娠9例),总妊娠率为67.1%,自然妊娠率为40.4%。 2.将所有病例分为妊娠组和非妊娠组,COX单因素分析提示：两组年龄、不孕时间、EFI评分、术后窦卵泡数、合并腺肌症、术后应用ART治疗有统计学差异(P0.1)。COX多因素分析提示：EFI评分、术后AFC、术后ART治疗为妊娠的保护性因素,合并腺肌症为危险因素。 3.EFI评分与累积总妊娠率分析,曲线下面积为0.662,临床截断值为7分,敏感度为0.717,特异性为0.518。EFI评分与累积自然妊娠率分析,曲线下面积为0.638,临床截断值为7分,敏感度为0.783,特异度为0.401。随着EFI评分的升高,累积总妊娠率及自然妊娠率均显著升高。 4.当EFI评分≤5分时,辅助生育技术的应用可以显著提高术后的累积总妊娠率,缩短妊娠的时间。 5.术后窦卵泡数(AFC)与总妊娠率分析,曲线下面积为0.662,临床截断值为9个,敏感度为0.543,特异性为0.735。在合并巧囊型病例中,曲线下面积为0.694,临床截断值为9个,敏感度为0.439,特异性为0.908。随着术后AFC数量的增多,累积总妊娠率显著升高。 结论 1.EFI评分、术后AFC、合并腺肌症、术后ART治疗与否与EMT合并不孕患者的术后妊娠结局密切相关。 2.行腹腔镜治疗手术一定程度上可以改善EMT合并不孕患者术后的妊娠结局。 3.采用EFI评分及窦卵泡计数可有效预测EMT合并不孕患者腹腔镜治疗术后妊娠结局,临床截断值分别为7分和9个。EFI评分≤5分时辅助生殖技术的应用可以改善妊娠结局,缩短妊娠时间。
[Abstract]:Purpose To explore the influencing factors of pregnancy and the value of predicting the outcome of pregnancy in patients with endometriosis complicated with infertility after laparoscopic treatment, and to provide scientific basis for clinical treatment. Method To collect, organize and follow up the history, surgical data, post-operative treatment and pregnancy outcome of patients with endometriosis associated with infertility who underwent laparoscopic surgery from April 2011 to December 2013. The relationship between age, r-AFS stage, antral follicle number, GnRH-a treatment after operation, ART treatment after operation and pregnancy after EMT combined with infertility were analyzed retrospectively. The data package is analyzed by SPSS19.0 statistical software. Result 1. From April 2011 to December 2013, a total of 489 patients were operated on, 57 cases were lost and 432 cases were followed up. Postoperative follow-up was 12-36 months. There were 290 cases of successful pregnancy (143 cases of natural pregnancy, 138 cases of IVF pregnancy, 9 cases of artificial insemination pregnancy). The total pregnancy rate was 67.1%, and the natural pregnancy rate was 40.4%. 2. All the cases were divided into pregnancy group and non-pregnancy group by Cox single factor analysis. The results showed that age, time of infertility, number of antral follicles after operation, and adenomyosis after operation were significantly different between the two groups. The multivariate analysis of ART showed that there was a significant difference between the two groups in terms of age, time of infertility, number of antral follicles and adenomyosis. Postoperative ART therapy was the protective factor of pregnancy, and adenomyosis was the risk factor. 3.EFI score and cumulative total pregnancy rate analysis showed that the area under the curve was 0.662, the clinical truncation value was 7 points, the sensitivity was 0.717, the specificity was 0.518.EFI score and cumulative natural pregnancy rate analysis, the area under the curve was 0.638, and the clinical truncation value was 7 points. The sensitivity and specificity were 0.783 and 0.401 respectively. With the increase of EFI score, the cumulative total pregnancy rate and the natural pregnancy rate increased significantly. 4. When the EFI score is 鈮，

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