發(fā)布時(shí)間：2018-04-25 11:48

  本文選題：腹腔鏡 + 子宮內(nèi)膜異位癥��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：不孕癥（infertility）指有生育要求的夫婦，規(guī)律性生活，未避孕一年未孕[1]。WHO預(yù)測(cè)，不孕將成為僅次于腫瘤和心腦血管疾病的第三大疾病[2]。正常妊娠的維持經(jīng)歷了卵巢排卵、精卵結(jié)合、受精卵輸送與胚胎著床及胚胎發(fā)育等多個(gè)步驟，任何一環(huán)節(jié)異常都可能導(dǎo)致整個(gè)妊娠過(guò)程失敗。子宮內(nèi)膜異位癥可以影響任一環(huán)節(jié)導(dǎo)致不孕發(fā)生。 子宮內(nèi)膜異位癥雖然是一種良性疾病，但其表現(xiàn)為惡性生物學(xué)行為：細(xì)胞增生、浸潤(rùn)和復(fù)發(fā)。子宮內(nèi)膜異位癥的臨床表現(xiàn)有很多種，臨床上主要表現(xiàn)為痛經(jīng)、性交痛、慢性盆腔痛、月經(jīng)不調(diào)和不孕。在不孕患者中，大約80%合并子宮內(nèi)膜異位癥[3]。子宮內(nèi)膜異位癥所引起的痛經(jīng)及慢性盆腔疼痛等嚴(yán)重影響了婦女的身體健康和生活質(zhì)量，不孕更是影響家庭的穩(wěn)定和正常生活。 子宮內(nèi)膜異位癥最主要的病變是粘連，包括盆腔粘連，輸卵管梗阻或周圍粘連。粘連的發(fā)生是個(gè)長(zhǎng)期、慢性的過(guò)程。子宮內(nèi)膜異位種植后隨月經(jīng)變化發(fā)生周期性出血，在卵巢局部形成內(nèi)含巧克力樣陳舊血的囊腫。囊腫逐漸增大，其內(nèi)壓力也逐漸增大，當(dāng)囊壁出現(xiàn)裂隙時(shí)囊內(nèi)巧克力樣液體便會(huì)自裂隙滲出，繼而引起卵巢周圍組織炎性反應(yīng)和纖維化，正�；|(zhì)缺損，受累卵泡顆粒細(xì)胞功能異常、激素水平異常等，而致卵巢排卵異常。中、重度內(nèi)異癥可破壞盆腔解剖結(jié)構(gòu)，如子宮與直腸粘連，輸卵管傘端粘連。子宮內(nèi)膜異位癥還能降低宮腔內(nèi)正常子宮內(nèi)膜對(duì)受精卵的容受性，造成宮內(nèi)種植障礙[4]。當(dāng)前廣泛使用的內(nèi)異癥分期標(biāo)準(zhǔn)為1985年美國(guó)生育學(xué)會(huì)AFS提出的“修正子宮內(nèi)膜異位癥分期法”[5]。此分期法將子宮內(nèi)膜異位癥分為四期：I期（微型）1-5分；II期（輕度）6-15分；III期（中度）16-40分；IV期（重度）＞40分。 卵巢是最容易受到異位子宮內(nèi)膜侵犯的的器官，約80%的內(nèi)異癥患者一側(cè)卵巢受累，約50%的患者雙側(cè)卵巢同時(shí)受累[6]。關(guān)于卵巢病變側(cè)別與術(shù)后妊娠率關(guān)系，有報(bào)道左側(cè)卵巢病變治療后易復(fù)發(fā)，妊娠率較右側(cè)低[7]，這可能與左側(cè)盆腔有乙狀結(jié)腸、容易發(fā)生組織粘連有關(guān)。亦推測(cè)可能與右側(cè)卵巢血供來(lái)自腹主動(dòng)脈(左側(cè)可來(lái)自左腎動(dòng)脈)，血運(yùn)豐富，卵巢功能恢復(fù)快有關(guān)。 年齡是影響卵巢儲(chǔ)備功能的重要因素之一。目前，年齡超過(guò)40歲是公認(rèn)的卵巢低反應(yīng)性的高危因素。隨著年齡增長(zhǎng)，卵巢卵泡數(shù)量迅速減少，卵母細(xì)胞質(zhì)量降低，卵母細(xì)胞核異常顯著增多，顆粒細(xì)胞凋亡率上升，卵泡閉鎖加速?gòu)亩鴮?dǎo)致女性生育能力下降。 子宮內(nèi)膜異位癥臨床類型，期別及子宮內(nèi)膜異位囊腫側(cè)別、直徑，患者年齡等均可能影響內(nèi)異癥不孕患者術(shù)后妊娠率。本文旨在研究子宮內(nèi)膜異位癥腹腔鏡術(shù)后的妊娠情況及子宮內(nèi)膜異位癥的臨床類型，期別及子宮內(nèi)膜異位囊腫側(cè)別、直徑，患者年齡對(duì)術(shù)后妊娠率的影響。 方法：回顧性分析2008-1至2013-1主因不孕并且有生育要求而就診于河北醫(yī)科大學(xué)第二醫(yī)院的女性患者病例。以確診為子宮內(nèi)膜異位癥的155例患者為研究對(duì)象，這些患者均行腹腔鏡探查術(shù)，，術(shù)后病理確診為子宮內(nèi)膜異位癥。統(tǒng)計(jì)分析其臨床及手術(shù)情況，包括年齡分布，術(shù)中病灶分布、粘連及子宮內(nèi)膜異位囊腫直徑，發(fā)生側(cè)別，術(shù)后分期，通過(guò)術(shù)后門診復(fù)查及電話隨訪術(shù)后妊娠情況，分析以上五個(gè)影響因素對(duì)術(shù)后妊娠率的影響。 結(jié)果：治療后155例患者中45例成功受孕，妊娠率29.03%(45/155)。妊娠率Ⅰ、Ⅱ、Ⅲ、Ⅳ期分別57.89%(11/19)、52.17%(12/23)、26.09%(18/69)、09.09%(4/44)，差別有統(tǒng)計(jì)學(xué)意義(X2=22.44，P＜0.05)，單純子宮內(nèi)膜異位囊腫術(shù)后妊娠率為44.23%(23/52)，子宮內(nèi)膜異位囊腫同時(shí)合并其他部位和僅其他部位內(nèi)膜異位癥術(shù)后妊娠率分別為16.13%(10/62)和29.27%(12/41)，差異有統(tǒng)計(jì)學(xué)意義(X2=10.84，P＜0.05)。右側(cè)子宮內(nèi)膜異位囊腫術(shù)后妊娠率為53.85%(21/39)，高于左側(cè)23.26%(10/43)和雙側(cè)5.71%(2/35)(X2=21.93，P＜0.05)。子宮內(nèi)膜異位囊腫直徑＜3cm術(shù)后妊娠率為55.00%(11/20)，3-5cm者為41.56%(32/77)，＞5cm者為20.69%(12/58)，差異有統(tǒng)計(jì)學(xué)意義（X2=10.11，P＜0.05）。年齡20-25歲妊娠率為53.85%(19/42)，26-30歲妊娠率為29.85%(20/67)，＞30歲妊娠率為13.04%(6/46)，差異有統(tǒng)計(jì)學(xué)意義（X2=11.08，P＜0.05）。 結(jié)論：子宮內(nèi)膜異位癥影響女性的生育能力是肯定的，子宮內(nèi)膜異位癥的臨床期別、內(nèi)異癥病灶部位、子宮內(nèi)膜異位囊腫發(fā)生側(cè)別及子宮內(nèi)膜異位囊腫直徑，患者年齡等對(duì)治療后妊娠率都有影響。及時(shí)的手術(shù)治療有利于妊娠率提高。
[Abstract]:Objective : infertility ( infertility ) refers to couples with reproductive health requirements , regular life , and no conception of contraception for one year . The WHO estimates that infertility will be the third major disease that is next to tumors and cardiovascular and cerebrovascular diseases . The maintenance of normal pregnancy has experienced many steps such as ovarian ovulation , fertilization , fertilization and embryo implantation and embryo development . Any abnormality in any link may lead to failure of the whole process of pregnancy . The endometriosis may affect any link to cause infertility .

Although endometriosis is a benign disease , it is characterized by malignant biological behavior : cell proliferation , infiltration and recurrence . The clinical manifestations of endometriosis are various , mainly in dysmenorrhea , sexual intercourse , chronic pelvic pain , irregular menstruation and infertility . Approximately 80 % of infertility patients combine endometriosis . dysmenorrhea and chronic pelvic pain caused by endometriosis have a serious impact on the physical health and quality of life of women , and the infertility affects the stability and normal life of the family .

The most important pathological changes in endometriosis are adhesions , including pelvic adhesion , obstruction of the fallopian tube or peripheral adhesion . The occurrence of adhesions is a chronic , chronic process . In 1985 , the clinical staging standard of endometriosis was divided into four stages : phase I ( micro ) 1 - 5 ;
Phase II ( mild ) 6 - 15 min ;
Phase III ( moderate ) 16 - 40 minutes ;
Phase IV ( severe ) > 40 points .

The ovaries are the most susceptible to ectopic endometrium invasion , about 80 % of the patients with endometriosis have ovarian involvement , and about 50 % of the patients have bilateral ovaries and are affected at the same time . The relationship between the side of the ovarian lesion and the pregnancy rate was reported . It was reported that the left ovary lesion was easy to recur after the treatment , and the pregnancy rate was lower than that of the right side . This could be related to the presence of sigmoid colon in the left pelvic cavity and easy tissue adhesion . It is also speculated that the right ovary blood may be related to the rapid recovery of ovarian function from the abdominal aorta ( left renal artery from the left side ) , abundant blood transport and recovery of ovarian function .

Age is one of the most important factors affecting ovarian reserve function . At present , the number of ovarian follicles is rapidly decreased , the quality of oocytes decreased , the number of oocytes was decreased , the apoptosis rate of granulose cells increased , and follicular atresia accelerated , resulting in a decline in female fertility .

The purpose of this study was to study the clinical types of endometriosis , the clinical types , the diameter of endometriosis , the influence of age on pregnancy rate after operation .

Methods : The clinical and operative conditions of 155 patients with endometriosis diagnosed as endometriosis were analyzed retrospectively , including age distribution , distribution of lesions in operation , adhesions and ectopic cyst diameter , incidence side , post - operative staging , post - operative outpatient review and post - operative pregnancy , and analyzed the effect of the above five factors on pregnancy rate after operation .

Results : The pregnancy rate was 53.85 % ( 11 / 19 ) , 52.17 % ( 12 / 23 ) , 26.09 % ( 18 / 69 ) , 09 . 09 % ( 12 / 23 ) , 26.09 % ( 18 / 69 ) , 09 . 09 % ( 12 / 23 ) , 26.09 % ( 18 / 69 ) , 09 . 09 % ( 4 / 44 ) respectively .

Conclusion : The effect of endometriosis on the fertility of women is positive , the clinical stage of endometriosis , the location of endometriosis , the incidence of endometriosis cyst , the diameter of ectopic cyst , the age of the patient and so on have an influence on the rate of pregnancy after treatment . The timely surgical treatment is beneficial to the improvement of pregnancy rate .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.71

【引證文獻(xiàn)】

相關(guān)期刊論文 前4條

1 張璐;周琦;;子宮內(nèi)膜異位囊腫發(fā)病特征及影響因素的調(diào)查[J];中國(guó)婦幼保健;2017年13期

2 徐丹;李東方;;子宮內(nèi)膜異位癥相關(guān)性不孕腹腔鏡術(shù)后妊娠率影響因素分析[J];現(xiàn)代儀器與醫(yī)療;2016年02期

3 馮燕;張婕;;子宮內(nèi)膜異位癥中西醫(yī)結(jié)合治療對(duì)患者孕育功能療效因素研究[J];中華中醫(yī)藥學(xué)刊;2016年03期

4 張杰;;輔助生殖技術(shù)治療子宮內(nèi)膜異位癥不孕患者的結(jié)局分析[J];臨床醫(yī)藥文獻(xiàn)電子雜志;2015年03期

本文編號(hào)：1801180