中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
Chinese Journal of General Practitioners
2015年
9期
678-681
,共4页
张红霞%刘霞%王丽萍%付伟平%朱琴%方春霞
張紅霞%劉霞%王麗萍%付偉平%硃琴%方春霞
장홍하%류하%왕려평%부위평%주금%방춘하
子宫内膜异位症%妊娠%促性腺激素释放激素%治疗结果
子宮內膜異位癥%妊娠%促性腺激素釋放激素%治療結果
자궁내막이위증%임신%촉성선격소석방격소%치료결과
Endometriosis%Pregnancy%Gonadotropin-releasing hormone%Treatment outcome
目的 探讨宫内膜异位症(EMs)不孕症患者腹腔镜术后应用促性腺激素释放激素激动剂(GnRH-a)对妊娠结局的影响.方法 对2010年1月至2012年12月在嘉兴市妇幼保健院因EMs不孕行腹腔镜手术后要求试孕患者222例,随机分组后完成规范治疗184例,其中1 10例应用长效GnRH-a治疗(每次3.75 mg,每28天注射1次,共3次)后试孕(GnRH-a组),74例直接试孕(对照组),术后试孕1 ～ 36个月.GnRH-a组中,EMs生育指数(EFI)为6～10分者83例(GnRH-a1组),EFI为0～5分者27例(GnRH-a2组);对照组中,EFI为6～10分者55例(对照1组),EFI为0～5分者19例(对照2组).结果 随访1～36个月,中位随访14个月.总累积妊娠率62％ (114/184),中位妊娠时间11个月.术后6个月累积妊娠率:GnRH-a组及其亚组累积妊娠率均低于对应对照组,其中GnRH-a组低于对照组9％(10/110)与32％ (24/74)、GnRH-a1组低于对照1组8％(7/83)与38％(21/55),差异有统计学意义(x2 =16.00,P＜0.01;x2=18.10,P＜0.01).术后12、24及36个月累积妊娠率:GnRH-a组及其亚组累积妊娠率均高于对应对照组,其中术后12个月时GnRH-a 1组与对照1组比较66％(55/83)与49％(27/55)差异有统计学意义(x2 =4.05,P＜0.05).GnRH-a组1年内妊娠比例88％(63/72)高于对照组76％ (32/42),差异无统计学意义(x2=2.44,P＞0.05).Kaplan-Meier生存分析累积妊娠率,GnRH-a组及其亚组与对应对照组比较,差异均无统计学意义(log-rank x2值分别为0.59、0.31和0.70,均P＞0.05),GnRH-a组及其亚组中位妊娠时间短于对应对照组,其中GnRH-a组中位妊娠时间(95％ CI)为10(8.2～11.8)个月,对照组为17(11.8～22.1)个月.GnRH-a组流产率11％ (8/72)低于对照组的26％ (11/42),差异有统计学意义(x2=4.34,P＜0.05).结论 EMs不孕患者尤其是生育力高的患者术后应用GnRH-a治疗3个周期可提高术后1年妊娠率,降低流产率.
目的 探討宮內膜異位癥(EMs)不孕癥患者腹腔鏡術後應用促性腺激素釋放激素激動劑(GnRH-a)對妊娠結跼的影響.方法 對2010年1月至2012年12月在嘉興市婦幼保健院因EMs不孕行腹腔鏡手術後要求試孕患者222例,隨機分組後完成規範治療184例,其中1 10例應用長效GnRH-a治療(每次3.75 mg,每28天註射1次,共3次)後試孕(GnRH-a組),74例直接試孕(對照組),術後試孕1 ～ 36箇月.GnRH-a組中,EMs生育指數(EFI)為6～10分者83例(GnRH-a1組),EFI為0～5分者27例(GnRH-a2組);對照組中,EFI為6～10分者55例(對照1組),EFI為0～5分者19例(對照2組).結果 隨訪1～36箇月,中位隨訪14箇月.總纍積妊娠率62％ (114/184),中位妊娠時間11箇月.術後6箇月纍積妊娠率:GnRH-a組及其亞組纍積妊娠率均低于對應對照組,其中GnRH-a組低于對照組9％(10/110)與32％ (24/74)、GnRH-a1組低于對照1組8％(7/83)與38％(21/55),差異有統計學意義(x2 =16.00,P＜0.01;x2=18.10,P＜0.01).術後12、24及36箇月纍積妊娠率:GnRH-a組及其亞組纍積妊娠率均高于對應對照組,其中術後12箇月時GnRH-a 1組與對照1組比較66％(55/83)與49％(27/55)差異有統計學意義(x2 =4.05,P＜0.05).GnRH-a組1年內妊娠比例88％(63/72)高于對照組76％ (32/42),差異無統計學意義(x2=2.44,P＞0.05).Kaplan-Meier生存分析纍積妊娠率,GnRH-a組及其亞組與對應對照組比較,差異均無統計學意義(log-rank x2值分彆為0.59、0.31和0.70,均P＞0.05),GnRH-a組及其亞組中位妊娠時間短于對應對照組,其中GnRH-a組中位妊娠時間(95％ CI)為10(8.2～11.8)箇月,對照組為17(11.8～22.1)箇月.GnRH-a組流產率11％ (8/72)低于對照組的26％ (11/42),差異有統計學意義(x2=4.34,P＜0.05).結論 EMs不孕患者尤其是生育力高的患者術後應用GnRH-a治療3箇週期可提高術後1年妊娠率,降低流產率.
목적 탐토궁내막이위증(EMs)불잉증환자복강경술후응용촉성선격소석방격소격동제(GnRH-a)대임신결국적영향.방법 대2010년1월지2012년12월재가흥시부유보건원인EMs불잉행복강경수술후요구시잉환자222례,수궤분조후완성규범치료184례,기중1 10례응용장효GnRH-a치료(매차3.75 mg,매28천주사1차,공3차)후시잉(GnRH-a조),74례직접시잉(대조조),술후시잉1 ～ 36개월.GnRH-a조중,EMs생육지수(EFI)위6～10분자83례(GnRH-a1조),EFI위0～5분자27례(GnRH-a2조);대조조중,EFI위6～10분자55례(대조1조),EFI위0～5분자19례(대조2조).결과 수방1～36개월,중위수방14개월.총루적임신솔62％ (114/184),중위임신시간11개월.술후6개월루적임신솔:GnRH-a조급기아조루적임신솔균저우대응대조조,기중GnRH-a조저우대조조9％(10/110)여32％ (24/74)、GnRH-a1조저우대조1조8％(7/83)여38％(21/55),차이유통계학의의(x2 =16.00,P＜0.01;x2=18.10,P＜0.01).술후12、24급36개월루적임신솔:GnRH-a조급기아조루적임신솔균고우대응대조조,기중술후12개월시GnRH-a 1조여대조1조비교66％(55/83)여49％(27/55)차이유통계학의의(x2 =4.05,P＜0.05).GnRH-a조1년내임신비례88％(63/72)고우대조조76％ (32/42),차이무통계학의의(x2=2.44,P＞0.05).Kaplan-Meier생존분석루적임신솔,GnRH-a조급기아조여대응대조조비교,차이균무통계학의의(log-rank x2치분별위0.59、0.31화0.70,균P＞0.05),GnRH-a조급기아조중위임신시간단우대응대조조,기중GnRH-a조중위임신시간(95％ CI)위10(8.2～11.8)개월,대조조위17(11.8～22.1)개월.GnRH-a조유산솔11％ (8/72)저우대조조적26％ (11/42),차이유통계학의의(x2=4.34,P＜0.05).결론 EMs불잉환자우기시생육력고적환자술후응용GnRH-a치료3개주기가제고술후1년임신솔,강저유산솔.
Objective To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a) on pregnancy outcome in patients with endometriosis infertility after laparoscopic surgery.Methods Two hundred and twenty two patients treated with laparoscopic surgery for endometriosis infertility in Jiaxing Maternal and Child Health Care Hospital between January 2010 and December 2012 were enrolled and 184 patients completed the study.Patients were randomly assigned to two groups:110 patients in GnRH-a group received long-acting GnRH-a (3.75 mg injection every 28 d for 3 times) before trying to conceive,74 patients in control group were directly trying to conceive for 1 to 36 months.According to endometriosis fertility index (EFI),patients were further subgrouped:GnRH-a group 1 (EFI scores =6-10,n =83),GnRH-a group 2 (EFI scores =0-5,n =27),control group 1 (EFI scores =6-10,n =55) and control group 2 (EFI scores =0-5,n =19).The cumulative pregnancy rate (CPR) and abortion rate were compared among groups and subgroups.Results The patients were followed up for 1 to 36 months after trying to conceive,with a median follow-up time of 14 months.The total CPR was 62％ (114/184),the median time for gestation was 11 months.Within the first 6 months after operation,the CPR in GnRH-a group and its subgroups were lower than those in corresponding control groups,with significant difference between GnRH-a group and control group [9％ (10/110) vs.32％ (24/74),x2 =16.00,P ＜0.01],GnRH-a group 1 and control group 1 [8％ (7/83) vs.38％ (21/55),x2 =18.10,P ＜0.01].Within 12 months,24 months and 36 months,the CPR in GnRH-a group and its subgroups were all higher than those in corresponding control groups [66％ (55/83) vs.49％ (27/55),x2 =4.05,P ＜ 0.05].The pregnant rate within 12 months in GnRH-a group was 88％ (63/72),which was not significantly different to that in control group [76％ (32/42),x2 =2.44,P ＞ 0.05].Kaplan-Meier analysis showed that there were no significant difference in CPR between GnRH-a group and control group,GnRH-a group 1 and control group 1,GnRH-a group 2 and control group 2 (all P ＞ 0.05).The median time for gestation in GnRH-a group and its subgroups were shorter than those in corresponding control group.The median time for gestation in GnRH-a group was 10 (95％ CI:8.2-11.8) months and that in control group was 17 (95％ CI:1l.8-22.1) months.The abortion rate in GnRH-a group and control group was 11％ (7/72) and 26％ (11/42),respectively (x2 =4.34,P ＜ 0.05).Conclusion Administration of GnRH-a for 3 cycles can improve postoperative pregnancy rate within 1 year and reduce the abortion rate for endometriosis infertile patients after laparoscopic surgery especially for these with strong fertility.
