Clinical Study of Laparoscopic Operations Combined With Endocrinal Therapy on Endometriosis Associated With Infertility.

To study the clinical value of laparoscopic operation combined with endocrinal therapy on endometriosis associated with infertility.

From 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).

In 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).

Laparoscopic operation can be used in the treatment of endometriosis associated with infertility. In the cases of stage Ⅲ and Ⅳ, laparoscopic operation combined with post-operative endocrinal therapy is of importance effects, and gonadotropin releasing hormone analogues is the best choice. | 1 Lian LJ, Lin QZ. Gynecological oncology. Beijing：People's Medical Publishing House, 2006, 837–838.[连利娟，林巧稚. 妇科肿瘤学. 北京：人民卫生出版社，2006，837–838.] | | | 2 Buyalos RP, Agarwal SK. Endometriosis–associated infertility. Curr Opin Obstet Gynecol, 2000, 12(5)：377–381. | | | 3 Gianetto–Berrutti A, Feyles V. Endometriosis related to infertility. Minerva Ginecol, 2003, 55(5)：407–416. | | | 4 Zhang XY. Practical obstetrics and gynecology. Beijing：People's Medical Publishing House, 2003, 746–750.[张惜阴. 实用妇产科学. 北京：人民卫生出版社，2003, 746–750.] | | | 5 Feng YJ. Obstetrics and gynecology. Beijing：People's Medical Publishing House, 2005, 361–362.[丰有吉. 妇产科学. 北京：人民卫生出版社，2005, 361–362.] | | | 6 Siristatidis C, Nissotakis C, Chrelias C, et al. Immunological factors and their role in the genesis and development of endometriosis. J Obstet Gynaecol Res, 2006, 32(2)：162–170. | | | 7 Gupta S, Agarwal A, Agarwal R, et al. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online, 2006, 13(3)：349–360. | | | 8 Graciela K, Frederick S, Hugh T, et al. Endometriosis and tissue factor. Ann NY Acad Sci, 2008, 1127(1)：101–105. | | | 9 Richter ON, Dorn C, Rosing B, et al. Tumor necrosis factor alpha secretion by peritoneal macrophages in patients with endometriosis. Arch Gynecol Obstet, 2005, 271(2)：143–147. | | | 10 Kalu E, Sumar N, Giannopoulos T, et al. Cytokine profiles in serum and peritoneal fluid from infertile women with and without endometriosis. J Obstet Gynaecol Res, 2007, 33(4)：490–495. | | | 11 Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril, 2004, 82(6)：1633–1637. | | | 12 Gilabert–Estelles J, Ramon LA, Espana F, et al. Expression of angiogenic factors in endometriosis: Relationship to fibrinolytic and metalloproteinase systems. Hum Reprod, 2007, 22(8)：2120–2127. | | | 13 Ishihara H, Kitawaki J, Kado N, et al. Gonadotropin–releasing hormone agonist and danazol normalize aromatase cytochrome P450 expression in eutopic endometrium from women with endometriosis, adenomyosis, or leiomyomas. Fertil Steril, 2003, 79(Suppl 1)：735–742. | | | 14 Zhao Y．Efficacy evaluation of laparoscopic operations combined with endocrinal therapy on endometriosis in the cases of Ⅲ and Ⅳ phases associated with infertility. J Wenzhou Med Coll, 2008, 38(1)：71–73.[赵宇．腹腔镜联合药物治疗重度EM及合并不孕症的疗效分析．温州医学院学报，2008, 38(1)：71–73.] | | | 15 Malinowski A, Nowak M, Maciolek–Blewniewska G, et al. The place of laparoscopy in gynecological practice––useful technique for diagnostic and treatment of infertility and endometriosis. Ginekol Pol, 2001, 72(12A)：1347–1354. | | | 16 Chen QH. Expression of estrogen receptor and progestin receptor in ectopic and eutopic endometrium in patients with endometriosis. J Fujian Med Univ, 2007, 38(3)：282–283.[陈琼华．子宫内膜异位症患者异位和在位子宫内膜ER和PR的表达. 福建医科大学学报，2007, 38(3)：282–283.] | | | 17 Wang Z, Yoshida S, Negoro K, et al. Polymorphisms in the estrogen receptor beta gene but not estrogen receptor alpha gene affect the risk of developing endometriosis in a Japanese population. Fertil Steril, 2004, 81(6)：1650–1656. | | | 18 Lang JH. Diagnosis and treatment of endometriosis. Progr Obstet Gynecol, 2005, 14(1)：5–8.[郎景和．子宫内膜异位症的诊断与处理．现代妇产科进展，2005，14(1)：5–8.] | | | 19 Lang JH. Assignment and future of endometriosis(Ⅱ). Chin J Obstet Gynecol, 2006, 41(10)：649–651.[郎景和．子宫内膜异位症研究的任务与展望(之二). 中华妇产科杂志，2006, 41(10)：649–651.] | | | 20 Olive DL. Optimizing gonadotropin–releasing hormone agonist therapy in women with endometriosis. Treat Endocrinol, 2004, 3(2)：83–89. | | | 21 Tsai YL，Hwang JL, Loo TC, et al. Short–term postoperative GnRH analogue or danazol treatment after conservative surgery for stage Ⅲ or Ⅳ endometriosis before ovarian stimulation: A prospective, randomized study. J Reprod Med, 2004, 49(12)：955–959. | | | 22 Shen FH. Efficacy evaluation of conservative surgery for different types of endometriosis associated infertility. J Pract Obstet Gynecol, 2008, 24(2)：88–91.[沈芳华. 保守性手术治疗对不同类型子宫内膜异位症合并不孕的疗效探讨. 实用妇产科杂志，2008，24(2)：88–91.] | | | 23 Szyllo K, Tchorzewski H, Banasik M, et al. The involvement of T lymphocytes in the pathogenesis of endometriotic tissues overgrowth in women with endometriosis. Mediators Inflamm, 2003, 12(3)：131–138. | | | 24 Zhang SF. Compare the changes of secretion of IL–2 and IL–6 in paients with endometriosis after the treatment of gonadotropin releasing hormone agonist (GnRHa) and estroprogestin. Fudan Univ J Med Sci, 2008, 35(2)：204–206.[张绍芬. GnRHa及反向雌孕激素对子宫内膜异位症患者外周血及腹腔液IL–2和IL–6分泌的影响．复旦学报(医学版), 2008，35(2)：204–206.] | | | 25 Emons G, Grundker C, Günthert AR, et al. GnRH antagonists in the treatment of gynecological and breast cancers. Endocr Relat Cancer, 2003, 10(2)：291–299. | | | 26 Gründker C, Günthert AR, Westphalen S, et al. Biology of the gonadotropin–releasing hormone system in gynecological cancers. Eur J Endocrinol, 2002, 146(1)：1–14. | | | 27 Borroni R, Di Blasio AM, Gafluri B, et al. Expression of GnRH receptor gene in human ectopic endometrial cells and inhibition of their proliferation by leuprolide acetate. Mol Cell Endocrinol, 2000, 159(2)：37–43. | | | 28 Meresman GF, Bilotas MA, Lombardi E, et al. Effect of GnRH analogues on apoptosis and release of interleukin–1beta and vascular endothelial growth factor in endometrial cell cultures from patients with endometriosis. Hum Reprod, 2003, 18(9)：1767–1771. | | | 29 Zhang YP. Expression and significance of GnRH and its receptors in endometrium of patients with endometriosis. Med J Chin People's Armed Police Forces, 2008, 19(4)：299–301.[张一萍. GnRH及其受体在子宫内膜异位组织的表达和意义．武警医学，2008, 19(4)：299–301.] | | | 30 Lin JF. Clinical study of effect of laparoscopic diagnosis and treatment on pelvic endometriosis associated infertility. Chin J Obstet Gynecol, 2005, 40(1)：9–12.[林金芳．应用腹腔镜诊断和治疗子宫内膜异位症及不孕症的疗效．中华妇产科杂志，2005, 40(1)：9–12.] | | [1] | 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13. | | [2] | 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14. | | [3] | 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4. | | [4] | 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8. | | [5] | 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12. | | [6] | 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18. | | [7] | 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22. | | [8] | 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26. | | [9] | 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34. | | [10] | 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313. | | [11] | 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314. | | [12] | 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315. | | [13] | 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143. | | [14] | 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144. | | [15] | 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145. | | 阅读次数 | ||||| | 全文 | | |||| | 摘要 | | |||| 版权所有 中华医学会 中华医学电子音像出版社有限责任公司 京ICP备14006079号-1 网络出版服务许可证：(署)网出证(京)字第075号 AI 小 编 AI小编