{"paper_id":"b91adcd9-1223-4e32-be86-084a3721553f","body_text":"中华妇幼临床医学杂志(电子版) ›› 2009, Vol. 05 ›› Issue (03) : 267 -271. doi: 10.3877/cma.j.issn.1673-5250.2009.03.115\n论著\n腹腔镜联合药物治疗子宫内膜异位症合并不孕的临床分析\n- 518052 深圳，广东医学院附属深圳市南山医院（深圳市第六人民医院）\n- Department of Gynecology, Shenzhen Nanshan Hospital Affiliated to Guangdong Medical College(Shenzhen Sixth People's Hospital), Shenzhen 518052, China\n目的\n探讨腹腔镜联合药物治疗子宫内膜异位症(endometriosis, EM)合并不孕的临床价值。\n方法\n选择2003年1月至2007年1月本院收治的Ⅰ～Ⅳ期子宫内膜异位症合并不孕患者341例为研究对象。对其在腹腔镜下子宫内膜异位症类型分别行粘连松解术、异位病灶电凝术、卵巢子宫内膜异位囊肿切除术、输卵管造口及通液术后，将各期患者随机分为A，B组和对照组。A组(n＝93)口服孕三烯酮(内美通，2.5 mg/粒，每周2次，每次1粒)，疗程为6个月。B组(n＝114)肌内注射醋酸曲普瑞林(达菲林，规格：3.75 mg/支，每4周1次，每次1支)，疗程3个月，对照组(n＝134)未用药。治疗后，随访1年，比较三组的妊娠结局。\n结果\n对于Ⅰ，Ⅱ期子宫内膜异位症合并不孕患者，A，B组平均受孕率为39.2%，对照组受孕率为30.1%，A，B组与对照组比较，差异无显著意义(P>0.05)。对于Ⅲ，Ⅳ期子宫内膜异位症合并不孕患者，A，B组平均受孕率为37.5%，对照组受孕率为23.0%，A，B组与对照组比较，差异无显著意义(P>0.05)；且B组受孕率(45.6%)高于A组(28.3%)，两组比较，差异有显著意义(P<0.05)。\n结论\n腹腔镜手术治疗，可提高子宫内膜异位症合并不孕患者的妊娠率，对于Ⅲ期、Ⅳ期的子宫内膜异位症合并不孕患者，腹腔镜术后联合药物治疗对提高妊娠率有重要作用。促性腺激素释放激素激动剂是腹腔镜术后联合药物治疗的最好选择。\nObjective\nTo study the clinical value of laparoscopic operation combined with endocrinal therapy on endometriosis associated with infertility.\nMethods\nFrom January 2003 to January 2007, a total of 341 cases of endometriosis(EM) associated with infertility who were underwent laparoscopic operations were included in this study. After the laparoscopic operation, they were divided into 3 groups, without endocrinal therapy group (control group, n=134), treated with gestrinone group (group A, n=93), and treated with gonadotropin releasing hormone analogues (GnRHa) group (group B, n=114).\nResults\nIn the cases of stage Ⅰ and Ⅱ, the pregnancy rate was 30.1% in control group and the average pregnant rate was 39.2% in group A and B. There had no significant difference among three groups (P>0.05). In the cases of stage Ⅲ and Ⅳ, the average pregnancy rates were 23.0% and 37.5% in control group and group B, C, respectively. There had no significant difference among three groups (P>0.05). The average pregnancy rate of group B (45.6%) was significant high than that of group A (28.3%) (P<0.05).\nConclusion\nLaparoscopic operation can be used in the treatment of endometriosis associated with infertility. 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