保守手术对卵巢子宫内膜异位患者妊娠结局的影响分析

发布时间：2018-06-19 22:05

本文选题：卵巢子宫内膜异位囊肿 + 保守手术　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:回顾性研究卵巢型子宫内膜异位症保守性手术治疗后的妊娠结局并分析相关影响因素。探讨术后有助改善妊娠率的方法手段。方法:收集2012年5月至2014年5月因卵巢子宫内膜异位囊肿于天津市中心妇产科医院行保守手术的患者454例,术后由病理证实诊断。有生育要求的257例,术后电话随访,失访47例,失访率18.2%,整理其余210例患者的临床资料。(1)按照术后妊娠情况分组:127例术后随访期间成功妊娠为妊娠组,80例截止随访结束依然未能获得妊娠为未妊娠组;随访时间48个月;以COX单因素分析年龄、囊肿大小、r-AFS分期等与妊娠结局的风险相关性;(2)按照术后干涉手段分组:单纯手术组及GnRH-a药物治疗组,比较各组患者的生育结局。结果:1.207例患者术后共妊娠127例,总积累妊娠率为65.2%,其中术后联合用药组与单纯手术组患者术后累积妊娠率分别是54.4%(68/125)、72%(59/82),2组间比较,差异有统计学意义(p0.05);同时各分期患者妊娠率均有明显改善,I—II、III-Ⅳ期患者累积妊娠率分别为67.5%(54/80)、57.5%(73/127),各分期间比较,差异无统计学意义(p0.05)。2.各处理组术后首次妊娠距手术平均时间比较,差异无显著性(p0.05)。术后4个月为受孕高峰,积累妊娠率22.8%,术后5个月累积妊娠率16.5%,术后半年累积妊娠率为11.8%,此后妊娠率下降明显,但手术1年半以后仍有一定妊娠率。3.将成功妊娠的病例分为自然妊娠组和辅助生殖组,将患者分为小于25岁,25-29岁,30-34岁和大于35岁四个年龄段,在单纯手术组和术后联合用药两个处理组间分别将自然妊娠率和ART妊娠率做比较。25岁及25-29岁两个年龄段间的自然妊娠率,差异有显著性。而4个年龄段间ART的妊娠率在两个处理组间无显著差异。4.按照术后妊娠情况分组,发现妊娠组与未妊娠组在年龄构成、包块直径及侧别、r-AFS评分及期别、不孕时间及术后ART的应用上均与妊娠结局无显著相关性。5.127例术后成功妊娠患者,41例为辅助生殖助孕后妊娠(包括促排卵后妊娠及IVF-ET),自然妊娠86例,占所有术后妊娠患者的67.7%;足月分娩80例,占63%,A组(术后联合用药组)35例,B组(单纯手术组)45例;有产科并发症的14例(如妊娠期糖尿病、FGR、前置胎盘、妊娠期高血压);早产共23例,A组22例,B组仅1例;胎停育共4例,各占2例;异位妊娠5例,A组3例,B组2例;B组胎儿畸形1例。术后联合用药组早产儿发生明显升高。结论:1.单纯手术可提高患者自然妊娠率,可改善患者生育能力,但术后应促进尽早妊娠,随着时间的推移,盆腔粘连、复发风险的增高,妊娠率也随之下降。2.各期别OEC患者妊娠率的差异无统计学意义,手术联合药物治疗对增加自然妊娠率无明显助益。3.术后GnRHa用药对改善生育作用有限,但可明显提高辅助生殖的临床妊娠率。4.手术治疗不增加不良妊娠结局,是否获益仍需大样本对照研究。5.本研究术后最佳妊娠期为4个月,但术后试孕多在1年以内受孕,如未成功获得妊娠,应建议其尽早行辅助生殖助孕,多数可顺利获得妊娠。
[Abstract]:Objective: To review the outcome of pregnancy after conservative surgical treatment of ovarian endometriosis and to analyze the related factors. Methods: to collect the methods to improve the pregnancy rate after operation. Methods: 454 patients with ovarian endometriosis in Tianjin Central Obstetrics and Gynecology Hospital from May 2012 to May 2014 were collected and the patients were operated on conservative operation in Tianjin Central Obstetrics and Gynecology Hospital. 257 cases with reproductive requirements, 257 cases of reproductive requirements, 47 cases of postoperative telephone follow-up, 47 cases of lost visit, 18.2% of the loss of visits, and the clinical data of the remaining 210 cases. (1) according to the postoperative pregnancy conditions, 127 cases were successfully pregnant and 80 cases were still unable to get pregnancy group. 48 months between 48 months; a single factor analysis of age, cyst size and r-AFS staging was associated with the risk of pregnancy outcome; (2) groups according to postoperative intervention: simple operation group and GnRH-a drug treatment group, compare the birth outcome of each group. Results: 127 cases of total pregnancy in 1.207 patients after operation, the total pregnancy rate was 65.2%, including postoperative Union. The cumulative pregnancy rate after operation was 54.4% (68/125) and 72% (59/82), respectively. The difference between the 2 groups was statistically significant (P0.05), and the pregnancy rate in each stage was significantly improved, and the cumulative pregnancy rate in I - II and III- IV patients was 67.5% (54/80) and 57.5% (73/127), respectively, and the difference was not statistically significant. There was no significant difference in the average time of the first gestation after operation of P0.05.2. (P0.05). 4 months after operation was the peak of pregnancy, the cumulative pregnancy rate was 22.8%, the cumulative pregnancy rate of 5 months after the operation was 16.5%, the cumulative pregnancy rate was 11.8% after the operation, and the pregnancy rate descended obviously after the operation, but there was still a certain pregnancy rate of.3. after the operation 1 and a half years. The cases of active pregnancy were divided into natural pregnancy group and auxiliary reproductive group. The patients were divided into 25 years old, 25-29 years old, 30-34 years old and four age groups over 35 years old. The natural pregnancy rate and ART pregnancy rate were compared between the natural pregnancy rate and the two treatment group, and the difference between the natural pregnancy rate and the 25-29 year old two age groups was compared between the simple operation group and the postoperative combined treatment group of two treatment groups. There was no significant difference in the pregnancy rate between the 4 age groups of the 4 age groups in the two treatment groups..4. was grouped according to the postoperatively pregnancy conditions. It was found that the age composition of the pregnancy group and the unpregnant group, the diameter of the packet and the side, the r-AFS score and the phase, the time of infertility and the application of ART after the operation were not significantly related to the pregnancy outcome, and the postoperative success was the success of.5.127. In pregnant women, 41 cases were assisted by reproductive pregnancy (including postovulatory pregnancy and IVF-ET), 86 cases of natural pregnancy, 67.7% of all postoperatively, 63% full term delivery, 35 cases in group A (combined group after operation), 45 cases in group B (simple operation group), and 14 cases of obstetric complications (such as gestational diabetes, FGR, placenta previa, pregnancy period) Hypertension): 23 cases of premature delivery, 22 cases in group A, 1 cases in group B, 4 cases of fetal parause, 2 cases of each, 5 cases of ectopic pregnancy, 3 cases in group A, 2 cases in group B, 1 cases of fetal malformation in group B. Conclusion: 1. simple operation can improve the patient's natural pregnancy rate and improve the fertility ability of the patients, but the early pregnancy should be promoted after operation, but the early pregnancy should be promoted with the operation. Time lapse, pelvic adhesions, recurrence risk increased, pregnancy rate also decreased in.2. different period OEC patients, the difference of pregnancy rate was not statistically significant, operation combined with drug treatment to increase natural pregnancy rate had no significant benefit.3. after the GnRHa medication to improve the fertility effect is limited, but can obviously improve the clinical pregnancy rate.4. hand of assisted reproduction. The surgical treatment does not increase the outcome of bad pregnancy. Whether the benefit still needs a large sample control study of.5., the best pregnancy period is 4 months after the study, but the postoperatively pregnant more than 1 years. If the pregnancy is not successfully obtained, it should be recommended to assist the reproductive pregnancy as early as possible, most of them can get the pregnancy smoothly.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.2

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