Ⅲ～Ⅳ期子宫内膜异位症患者保守性手术后的结局分析

目的探讨Ⅲ～Ⅳ期子宫内膜异位症患者保守性手术后的复发和妊娠结局。方法回顾性分析90例Ⅲ～Ⅳ期子宫内膜异位症患者的临床资料,均行保留子宫和部分卵巢的保守性手术。16例患者单纯行保守性手术（术后未用药,A组）,52例术后予孕三烯酮治疗（B组）,22例术后予促性腺激素释放激素激动剂（GnRHa）治疗（C组）。3组中不孕症患者分别是10、15和10例。随访24～84个月（中位时间是48．5个月）,比较3组患者的术后复发、妊娠情况及妊娠结局。结果A、B、C3组的复发率分别是18．8％（3／16）、30．8％（16／52）和13．6％（3／22）,3组比较,差异无统计学意义（P=0．247）;3组的平均复发时间分别是术后63．8、63．3和47．6个月,3组比较,差异无统计学意义（P=0．376）。3组中不孕症患者,术后累积妊娠率分别是70．0％（7／10）、66．7％（10／15）和60．O％（6／10）,3组间比较,差异无统计学意义（P=0．890）;术后首次妊娠距手术的时间间隔比较,差异无统计学意义（P=0．092）;而且65．2％（15／23）是在术后1年内自然妊娠。结论保守性手术后采用孕三烯酮或GnRHa巩固治疗未能延缓复发时间,也不能降低复发率。手术能改善Ⅲ～Ⅳ期患者的生育力,但术后药物治疗不能提高妊娠率。

Outcome analysis of stage III - IV endometriosis after conservative surgery

OBJECTIVE: To analyze the recurrence and fertility outcome of stage III - IV endometriosis after conservative surgery. METHODS: A retrospective study was performed on 90 women with stage III - IV endometriosis who had been diagnosed by pathology after conservative surgery. They were divided into three groups: 16 without endocrine therapy (Group A), 52 treated with gestrinone (Group B), 22 treated with gonadotropin releasing hormone agonist (GnRHa) (Group C). The number of infertile patients in the three groups was 10, 15 and 10, respectively. The recurrent and pregnant outcomes were compared after a median follow-up of 48.5 months (2 - 7 years). RESULTS: The recurrent rate of groups A, B, and C was 18.8% (3/16), 30.8% (16/52) and 13.6% (3/22), respectively (P = 0.247); the recurrent time in the three groups were Group A: 63.8 months, Group B: 63.3 months, and Group C: 47.6 months (P = 0.376). There were no significant differences in pregnant outcome among the three groups. The cumulative pregnant rates were 70.0% (7/10), 66.7% (10/15) and 60.0% (6/10), respectively (P = 0.890). There was also no difference in the first pregnant interval after surgery (P = 0.092) and 65.2% of the patients acquired pregnancy spontaneously in the first year after surgery. CONCLUSIONS: Neither gestrinone nor GnRHa can prolong the recurrent time or reduce the recurrent rate after conservative surgery. Surgery can improve the fertility ability of stage III and IV endometriosis patients; however, the pregnant rate cannot be improved with endocrine therapy after conservative surgery.