[1]刘 丹,梁新新.育龄期子宫内膜异位症合并不孕症患者临床特征及腹腔镜术后辅助生殖妊娠结局影响因素分析[J].陕西医学杂志,2021,50(4):409-412,420.[doi:DOI:10.3969/j.issn.1000-7377.2021.04.006]
　LIU Dan,LIANG Xinxin.Clinical characteristics of endometriosis patients with infertility in childbearing age and influencing factors of assisted reproductive pregnancy outcome after laparoscopic surgery[J].,2021,50(4):409-412,420.[doi:DOI:10.3969/j.issn.1000-7377.2021.04.006]
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育龄期子宫内膜异位症合并不孕症患者临床特征及腹腔镜术后辅助生殖妊娠结局影响因素分析
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年4期
页码:
409-412,420
栏目:
临床研究
出版日期:
2021-04-05

文章信息/Info

Title:
Clinical characteristics of endometriosis patients with infertility in childbearing age and influencing factors of assisted reproductive pregnancy outcome after laparoscopic surgery
作者:
刘 丹; 梁新新
(空军军医大学唐都医院妇产科生殖医学中心,陕西 西安710038)
Author(s):
LIU Dan; LIANG Xinxin
(Reproductive Medicine Center,Department of Obstetrics and Gynecology,Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)
关键词:
子宫内膜异位症;  不孕症;  临床特征;  手术治疗;  辅助生殖;  妊娠结局
Keywords:
Endometriosis;  Infertility;  Clinical features;  Surgical treatment;  Assisted reproduction;  Pregnancy outcome
分类号:
R 711.71
DOI:
DOI:10.3969/j.issn.1000-7377.2021.04.006
文献标志码:
A
摘要:
目的:探究育龄期子宫内膜异位症(EMT)合并不孕症患者临床特征及影响患者术后辅助生殖妊娠结局的相关因素,以期为有生育需求女性疾病诊断及治疗提供参考。方法:回顾性分析268例育龄期EMT合并不孕症患者,统计患者入院时自述主要症状、检查结果、术中探查及术后助孕结果。对比分析术后助孕成功和失败者临床资料。结果:育龄期EMT合并不孕症早期症状主要表现痛经及下腹痛(72.01%)、月经不调(20.90%)、性交痛(18.28%)、肛门坠胀痛(11.19%)等,少数患者自觉无明显症状(4.10%); 主要体征表现为子宫内倾且活动受限(44.03%)、附件区囊性包块且活动受限(33.96%)、子宫增大(27.61%)、宫底韧带增粗且有触痛(15.30%)、子宫直肠窝有触痛结节(12.31%)等; 病灶病理类型主要为腹膜型10.45%、卵巢型69.40%、深层浸润型7.84%、腹膜+卵巢型8.96%、腹膜型+卵巢型+深层浸润型4.10%。单因素和多因素二元Logistic回归分析显示,高龄(≥40岁)是EMT合并不孕患者术后助孕成功的危险因素,患者生育指数(EFI)、人绒毛膜促性腺激素(hCG)及子宫内膜厚度(ET)(8～14 mm)、获卵数目及可移植胚胎数为术后助孕成功的保护性因素(均P<0.05)。结论:EMT合并不孕症多数具有明显症状,详细准确掌握患者、体征,有助于及时确诊,EMT术后辅以体外受精-胚胎移植(IVF-ET)可助育龄期女性获得较好妊娠结局,但能否助孕成功仍受年龄、促排方案、生育指数等多重因素影响,临床需做好积极干预。
Abstract:
Objective:To explore the clinical characteristics of endometriosis(EMT)patients with infertility in childbearing age and the related factors influencing the outcome of assisted reproductive pregnancy,so as to provide reference for the diagnosis and treatment of women with reproductive needs.Methods:The clinical data of 268 EMT patients with infertility in childbearing age were retrospectively analyzed.The main symptoms,examination results,intraoperative exploration and postoperative assisted pregnancy results were recorded when the patients were admitted.The clinical data of successful and unsuccessful fertilization after surgery were compared.Results:The early symptoms of EMT patients complicated with infertility in childbearing age mainly manifested as dysmenorrhea and lower abdominal pain(72.01%),irregular menstruation(20.90%),dyspareunia(18.28%),anal swelling pain(11.19%),and a few patients felt no obvious symptoms(4.10%); the main signs were introverted uterus and restricted movement(44.03%),cystic mass in the adnexal area and restricted movement(33.96%),enlarged uterus(27.61%),thickened fundus ligament and there are tenderness(15.30%),tender nodules(12.31%)in the uterine rectal fossa,etc.; the main pathological types of the lesions were peritoneal(10.45%),ovarian(69.40%),deep infiltration(7.84%),peritoneal+ovarian(8.96%),peritoneal+ovarian +deep infiltration(4.10%).The univariate and multivariate binary logistic regression analysis showed that advanced age(≥40 years old)was a risk factor for the success of postoperative assisted pregnancy in patients with EMT and infertility,EFI,hCG day ET(8～14 mm),the number of eggs obtained and the number of embryos that could be transferred were the protective factors for the success of postoperative assisted pregnancy(all P<0.05).Conclusion:Most of EMT complicated with infertility have obvious symptoms.Detailed and accurate understanding of patients and signs can help timely diagnosis.In vitro fertilization-embryo transfer(IVF-ET)after EMT can help women in childbearing age to achieve better pregnancy outcomes.However,the success of assisted pregnancy is still affected by multiple factors such as age,ovulation promotion program,fertility index,etc,and active clinical intervention is needed.

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备注/Memo

备注/Memo:
基金项目:陕西省科学技术委员会科研计划项目(16211690101); 空军军医大学唐都医院科技创新发展基金资助项目(2017JCY002)
更新日期/Last Update: 2021-04-06