本文選題：卵巢子宮內(nèi)膜異位囊腫 + 保守手術(shù)�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:回顧性研究卵巢型子宮內(nèi)膜異位癥保守性手術(shù)治療后的妊娠結(jié)局并分析相關(guān)影響因素。探討術(shù)后有助改善妊娠率的方法手段。方法:收集2012年5月至2014年5月因卵巢子宮內(nèi)膜異位囊腫于天津市中心婦產(chǎn)科醫(yī)院行保守手術(shù)的患者454例,術(shù)后由病理證實診斷。有生育要求的257例,術(shù)后電話隨訪,失訪47例,失訪率18.2%,整理其余210例患者的臨床資料。(1)按照術(shù)后妊娠情況分組:127例術(shù)后隨訪期間成功妊娠為妊娠組,80例截止隨訪結(jié)束依然未能獲得妊娠為未妊娠組;隨訪時間48個月;以COX單因素分析年齡、囊腫大小、r-AFS分期等與妊娠結(jié)局的風(fēng)險相關(guān)性;(2)按照術(shù)后干涉手段分組:單純手術(shù)組及GnRH-a藥物治療組,比較各組患者的生育結(jié)局。結(jié)果:1.207例患者術(shù)后共妊娠127例,總積累妊娠率為65.2%,其中術(shù)后聯(lián)合用藥組與單純手術(shù)組患者術(shù)后累積妊娠率分別是54.4%(68/125)、72%(59/82),2組間比較,差異有統(tǒng)計學(xué)意義(p0.05);同時各分期患者妊娠率均有明顯改善,I—II、III-Ⅳ期患者累積妊娠率分別為67.5%(54/80)、57.5%(73/127),各分期間比較,差異無統(tǒng)計學(xué)意義(p0.05)。2.各處理組術(shù)后首次妊娠距手術(shù)平均時間比較,差異無顯著性(p0.05)。術(shù)后4個月為受孕高峰,積累妊娠率22.8%,術(shù)后5個月累積妊娠率16.5%,術(shù)后半年累積妊娠率為11.8%,此后妊娠率下降明顯,但手術(shù)1年半以后仍有一定妊娠率。3.將成功妊娠的病例分為自然妊娠組和輔助生殖組,將患者分為小于25歲,25-29歲,30-34歲和大于35歲四個年齡段,在單純手術(shù)組和術(shù)后聯(lián)合用藥兩個處理組間分別將自然妊娠率和ART妊娠率做比較。25歲及25-29歲兩個年齡段間的自然妊娠率,差異有顯著性。而4個年齡段間ART的妊娠率在兩個處理組間無顯著差異。4.按照術(shù)后妊娠情況分組,發(fā)現(xiàn)妊娠組與未妊娠組在年齡構(gòu)成、包塊直徑及側(cè)別、r-AFS評分及期別、不孕時間及術(shù)后ART的應(yīng)用上均與妊娠結(jié)局無顯著相關(guān)性。5.127例術(shù)后成功妊娠患者,41例為輔助生殖助孕后妊娠(包括促排卵后妊娠及IVF-ET),自然妊娠86例,占所有術(shù)后妊娠患者的67.7%;足月分娩80例,占63%,A組(術(shù)后聯(lián)合用藥組)35例,B組(單純手術(shù)組)45例;有產(chǎn)科并發(fā)癥的14例(如妊娠期糖尿病、FGR、前置胎盤、妊娠期高血壓);早產(chǎn)共23例,A組22例,B組僅1例;胎停育共4例,各占2例;異位妊娠5例,A組3例,B組2例;B組胎兒畸形1例。術(shù)后聯(lián)合用藥組早產(chǎn)兒發(fā)生明顯升高。結(jié)論:1.單純手術(shù)可提高患者自然妊娠率,可改善患者生育能力,但術(shù)后應(yīng)促進(jìn)盡早妊娠,隨著時間的推移,盆腔粘連、復(fù)發(fā)風(fēng)險的增高,妊娠率也隨之下降。2.各期別OEC患者妊娠率的差異無統(tǒng)計學(xué)意義,手術(shù)聯(lián)合藥物治療對增加自然妊娠率無明顯助益。3.術(shù)后GnRHa用藥對改善生育作用有限,但可明顯提高輔助生殖的臨床妊娠率。4.手術(shù)治療不增加不良妊娠結(jié)局,是否獲益仍需大樣本對照研究。5.本研究術(shù)后最佳妊娠期為4個月,但術(shù)后試孕多在1年以內(nèi)受孕,如未成功獲得妊娠,應(yīng)建議其盡早行輔助生殖助孕,多數(shù)可順利獲得妊娠。
[Abstract]:Objective: To review the outcome of pregnancy after conservative surgical treatment of ovarian endometriosis and to analyze the related factors. Methods: to collect the methods to improve the pregnancy rate after operation. Methods: 454 patients with ovarian endometriosis in Tianjin Central Obstetrics and Gynecology Hospital from May 2012 to May 2014 were collected and the patients were operated on conservative operation in Tianjin Central Obstetrics and Gynecology Hospital. 257 cases with reproductive requirements, 257 cases of reproductive requirements, 47 cases of postoperative telephone follow-up, 47 cases of lost visit, 18.2% of the loss of visits, and the clinical data of the remaining 210 cases. (1) according to the postoperative pregnancy conditions, 127 cases were successfully pregnant and 80 cases were still unable to get pregnancy group. 48 months between 48 months; a single factor analysis of age, cyst size and r-AFS staging was associated with the risk of pregnancy outcome; (2) groups according to postoperative intervention: simple operation group and GnRH-a drug treatment group, compare the birth outcome of each group. Results: 127 cases of total pregnancy in 1.207 patients after operation, the total pregnancy rate was 65.2%, including postoperative Union. The cumulative pregnancy rate after operation was 54.4% (68/125) and 72% (59/82), respectively. The difference between the 2 groups was statistically significant (P0.05), and the pregnancy rate in each stage was significantly improved, and the cumulative pregnancy rate in I - II and III- IV patients was 67.5% (54/80) and 57.5% (73/127), respectively, and the difference was not statistically significant. There was no significant difference in the average time of the first gestation after operation of P0.05.2. (P0.05). 4 months after operation was the peak of pregnancy, the cumulative pregnancy rate was 22.8%, the cumulative pregnancy rate of 5 months after the operation was 16.5%, the cumulative pregnancy rate was 11.8% after the operation, and the pregnancy rate descended obviously after the operation, but there was still a certain pregnancy rate of.3. after the operation 1 and a half years. The cases of active pregnancy were divided into natural pregnancy group and auxiliary reproductive group. The patients were divided into 25 years old, 25-29 years old, 30-34 years old and four age groups over 35 years old. The natural pregnancy rate and ART pregnancy rate were compared between the natural pregnancy rate and the two treatment group, and the difference between the natural pregnancy rate and the 25-29 year old two age groups was compared between the simple operation group and the postoperative combined treatment group of two treatment groups. There was no significant difference in the pregnancy rate between the 4 age groups of the 4 age groups in the two treatment groups..4. was grouped according to the postoperatively pregnancy conditions. It was found that the age composition of the pregnancy group and the unpregnant group, the diameter of the packet and the side, the r-AFS score and the phase, the time of infertility and the application of ART after the operation were not significantly related to the pregnancy outcome, and the postoperative success was the success of.5.127. In pregnant women, 41 cases were assisted by reproductive pregnancy (including postovulatory pregnancy and IVF-ET), 86 cases of natural pregnancy, 67.7% of all postoperatively, 63% full term delivery, 35 cases in group A (combined group after operation), 45 cases in group B (simple operation group), and 14 cases of obstetric complications (such as gestational diabetes, FGR, placenta previa, pregnancy period) Hypertension): 23 cases of premature delivery, 22 cases in group A, 1 cases in group B, 4 cases of fetal parause, 2 cases of each, 5 cases of ectopic pregnancy, 3 cases in group A, 2 cases in group B, 1 cases of fetal malformation in group B. Conclusion: 1. simple operation can improve the patient's natural pregnancy rate and improve the fertility ability of the patients, but the early pregnancy should be promoted after operation, but the early pregnancy should be promoted with the operation. Time lapse, pelvic adhesions, recurrence risk increased, pregnancy rate also decreased in.2. different period OEC patients, the difference of pregnancy rate was not statistically significant, operation combined with drug treatment to increase natural pregnancy rate had no significant benefit.3. after the GnRHa medication to improve the fertility effect is limited, but can obviously improve the clinical pregnancy rate.4. hand of assisted reproduction. The surgical treatment does not increase the outcome of bad pregnancy. Whether the benefit still needs a large sample control study of.5., the best pregnancy period is 4 months after the study, but the postoperatively pregnant more than 1 years. If the pregnancy is not successfully obtained, it should be recommended to assist the reproductive pregnancy as early as possible, most of them can get the pregnancy smoothly.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.2

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