网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
EMT合并不孕症宫腹腔镜联合治疗后妊娠现状及相关危险因素分析
作者:王庚  韩亚田  王军 
单位:本溪市中心医院 妇产科, 辽宁 本溪 117000
关键词:子宫内膜异位症 不孕症 腹腔镜手术 妊娠现状 危险因素 
分类号:R714.15
出版年·卷·期(页码):2020·39·第八期(984-989)
摘要:

目的:探究子宫内膜异位症(endometriosis,EMT)合并不孕症宫腹腔镜联合治疗后妊娠现状及相关危险因素分析。方法:选择2014年1月至2017年6月间在我院行腹腔镜根治术的342例EMT合并不孕症患者,13例患者失访,根据术后两年是否妊娠,将患者分成未妊娠组(n=124)和妊娠组(n=205)。单因素分析两组患者的基线资料,对差异有统计学意义的单因素进行非条件Logistic多因素回归分析,探究术后未妊娠的影响因素并建立其预测模型。结果:329例EMT患者中,未妊娠发生率为37.69%(124/329)。两组患者在年龄、不孕时间、子宫内膜异位症分期、不孕类型、输卵管堵塞、子宫肌腺病、生殖辅助技术、服用GnRH-a及子宫内膜异位症生育指数等指标差异有统计学意义(P<0.05)。Logistic回归分析表明年龄(OR=1.478,95% CI:1.213~1.802)、不孕时间(OR=2.667,95% CI:1.367~5.204)、输卵管堵塞(OR=1.831,95% CI:1.242~2.700)、生殖辅助技术(OR=0.417,95% CI:0.281~0.619)、子宫内膜异位症生育指数(OR=0.312,95% CI:0.168~0.580)及继发性不孕(OR=2.252,95% CI:1.525~3.327)等6项指标是发生妊娠的独立影响因素(P<0.05),得到拟合方程为logit(P)=-0.764+0.391X1+0.981X2+0.605X3-0.874X4-1.164X5+0.812X6,其中X1代表年龄,X2代表不孕时间,X3代表输卵管堵塞,X4代表生殖辅助技术,X5代表子宫内膜异位症生育指数和X6代表继发性不孕。结论:329例EMT合并不孕症患者中,未妊娠发生率为37.69%(124/329)。年龄、不孕时间、输卵管堵塞、生殖辅助技术、子宫内膜异位症指数及继发性不孕等指标是影响患者妊娠的独立影响因素,临床应针对上述因素制定针对性方案,以提高术后妊娠率。

Objective: To explore the analysis of pregnancy status and related risk factors after uterine laparoscopic surgery of EMT complicated with infertility. Methods: A total of 342 patients with EMT complicated with infertility,who underwent laparoscopic radical surgery in our hospital from January 2014 to June 2016 were selected as the observation group, 13 patients were lost during the follow-up period. According to whether the patients were pregnant two years after operation, the patients were divided into non-pregnancy group (n=124) and pregnancy group (n=205).The basic information of the two groups was compared for single factor analysis, and the significantly different single factors were analyzed by non-conditional logistic regression analysis, the influence factors for non-pregnancy and the forecast model were established. Results: Among the 329 patients with EMT, the incidence of non-pregnancy was 37.69% (124/329). The differences in age, duration of infertility, staging of endometriosis, type of infertility, tubal obstruction, adenomyosis, reproductive aids, administration of GnRH-a and fertility index of endometriosis were statistically significant (P<0.05). Logistic regression analysis showed age (OR=1.478, 95% CI:1.213~1.802), infertility time (OR=2.667, 95% CI:1.367~5.204), tubal blockage (OR=1.831, 95% CI:1.242~2.700), reproductive assistance technology (OR=0.417, 95% CI:0.281~0.619), endometriosis fertility index (OR=0.312, 95% CI:0.168~0.580) and secondary infertility (OR=2.252, 95% CI:1.525~3.327) were independent influencing factors of pregnancy (P<0.05), and logit(P)=-0.764+0.391X1+0.981X2+0.605X3-0.874X4-1.164X5+0.812X6, X1 representing age, X2 representing infertility time, X3 representing tubal blockage, X4 representing reproductive assistive technology, X5 representing endometriosis fertility index and X6 representing secondary infertility.Conclusion: Among the 329 patients with EMT complicated with infertility, the incidence of non-pregnancy was 37.69% (124/329). Age, infertility time, tubal blockage, reproductive assistant technology, endometriosis index and secondary infertility are the independent influencing factors of pregnancy. Clinical measures should develop targeted program to improve postoperative pregnancy rates according to the above indexes.

参考文献:

[1] YOO J Y,KIM T H,FAZLEABAS A T,et al.KRAS activation and over-expression of sirt1/bcl6 contributes to the pathogenesis of endometriosis and progesterone resistance[J].Sci Rep,2017,7(1):6765.
[2] LI J,YANG H,SONG J.Effect of laparoscopy combined with mifepristone in the treatment of endometriosis and drug reaction analysis[J].Pak J Pharm Sci,2018,31(3):1157-1161.
[3] STRUBLE J,REID S,BEDAIWY M A.A clinical review of a challenging gynecologic condition[J].J Minim Invasive Gynecol,2016,23(2):164-185.
[4] 赵玲娟,孔方方,邵艳社.子宫内膜异位症中西医治疗进展[J].解放军医药杂志,2015,27(6):114-116.
[5] 陈行,苏椿淋,陆鹏荣.腹腔镜术后联合GnRH-a治疗子宫内膜异位症合并不孕患者主观症状、性激素水平及妊娠结局[J].中国计划生育学杂志,2019,27(5):624-627.
[6] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015(3):161-169.
[7] YANGR,XU T,FU Y,et al.Leiomyomatosis peritonealis disseminata associated with endometriosis:a case report and review of the literature[J].Oncol Lett,2015,9(2):717-720.
[8] JANA S,CHATTERJEE K,RAY A K,et al.Regulation of matrix metalloproteinase-2 activity by cox-2-pge2-pakt axis promotes angiogenesis in endometriosis[J].Plos One,2016,11(10):e0163540.
[9] CHAICHIAN S,KABIR A,MEHDIZADEHKASHI A,et al.Comparing the efficacy of surgery and medical therapy for pain management in endometriosis:a systematic review and meta-analysis[J].Pain Physician,2017,20(3):185-195.
[10] 张春晓.子宫内膜异位症相关性不孕患者腹腔镜术后妊娠情况及影响因素分析[J].中国妇幼保健,2018,33(12):2761-2764.
[11] GLAVIND M T,FORMAN A,ARENDT L H,et al.Endometriosis and pregnancy complications[J].Fertil Steril,2017,107(1):160-166.
[12] 王艳,李文青,任青玲,等.中医药综合外治法治疗盆腔炎性疾病后遗症临床效果[J].中国计划生育学杂志,2018,26(8):740-743.
[13] OJULE J D,IBE V C,THEOPHILUS J C.Chlamydia trachomatis infection and tubal infertility in port harcourt,southern,Nigeria[J].West Afr J Med,2015,34(2):83-88.
[14] SORMUNEN T,ANESEN A,BJÖÖRN F,et al.Infertility-related communication and coping strategies among women affected by primary or secondary infertility[J].J Clin Nurs,2017,27(1):e335-e344.
[15] 汤海瑜,高天旸.子宫内膜异位症的诊疗——解读欧洲人类生殖及胚胎学会(ESHRE)新指南[J].中国生育健康杂志,2015,26(2):176-180.
[16] IVERSEN M L,SEYER-HANSEN M,FORMAN A.Does surgery for deep infiltrating bowel endometriosis improve fertility? A review[J].Acta Obstet Gynecol Scand,2017,96(6):688-693.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 458640 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541