摘要
目的探讨卵巢子宫内膜异位囊肿合并不孕的患者腹腔镜术后影响自然妊娠的因素。方法选取2017年5月至2020年5月廊坊市人民医院收治的经腹腔镜手术治疗的卵巢子宫内膜异位囊肿合并不孕患者70例为研究对象,随访观察2年,根据患者术后自然妊娠情况分为妊娠组49例,非妊娠组21例,比较两组患者的体质量指数(BMI)、不孕年限、不孕类型及囊肿情况等临床资料,对显著差异指标进行Logistic回归分析,建立影响妊娠因素的预测模型,使用受试者工作特征(ROC)曲线下面积(AUC)对不同模型进行比较,分析腹腔镜术后影响妊娠的因素及子宫内膜异位症生育指数评分(EFI)的预测价值。结果两组在BMI、不孕类型、囊肿的位置、类型和直径、修订的美国生育学会分期(rAFS)痛经程度、有无腹膜子宫内膜异位症(PEM)或深部浸润子宫内膜异位症(DIE)以及术后辅助用药等方面均无显著差异(P>0.05)。在模型1中,不孕年限[OR=0.522,95%CI(0.337,0.807),P=0.003]、双侧囊肿[OR=0.218,95%CI(0.052,0.910),P=0.037]和rAFSⅢ期[OR=0.062,95%CI(0.006,0.654),P=0.021]是术后妊娠的独立影响因素;在模型2中,只有EFI[OR=5.395,95%CI(2.328,12.500),P<0.05]是术后妊娠的独立影响因素。EFI评分[AUC=0.937,95%CI(0.873,1.000),P<0.05]和模型2[AUC=0.949,95%CI(0.890,1.000),P<0.05]的AUC显著高于模型1[AUC=0.856,95%CI(0.758,0.954),P<0.05],EFI和模型2之间的AUC没有显著性差异(P>0.05)。结论卵巢子宫内膜异位囊肿合并不孕患者不孕年限、双侧囊肿、rAFSⅢ期和EFI是影响术后自然妊娠的主要因素。EFI评分虽然有不足,但是目前仍是最理想的术后妊娠评估指标。
Objective:To explore the influencing factors of nature pregnancy in infertile patients with ovarian endometriosis cysts after laparoscopic surgery.Methods:Seventy infertile patients with ovarian endometriosis cysts who were treated by laparoscopic surgery in the People’s Hospital of Langfang City from May 2017 to May 2020 were selected as the subjects,and they were followed-up for 2 years.According to the postoperative natural pregnancy status of the patient,they were divided into the pregnancy group(n=49)and the non-pregnancy group(n=21).The body mass index(IBM),the infertility duration,the infertility type,and the cysts status were compared between the two groups.Logistic regression analysis was used to analyze the significantly different indicators.Then the predictive models for the factors affecting the pregnancy were established.The different models were compared by using the area under the receiver operating characteristic(ROC)curve(AUC),and the factors that affect pregnancy after laparoscopic surgery and the predictive value of endometriosis fertility index(EFI)score were analyzed.Results:There were no differences in the body mass index(IBM),infertility duration,infertility type,and the location,type,and diameter of cysts,the degree of dysmenorrhea according to the revised American Fertility Society staging(rAFS),presence or absence of peritoneal endometriosis(PEM)or deeply infiltrating endometriosis(DIE),and postoperative adjuvant medication,etc.between the two groups.In model 1,the infertility duration[OR=0.522,95%CI(0.337,0.807),P=0.003],bilateral cysts[OR=0.218,95%CI(0.052,0.910),P=0.037],and rAFS stageⅢ[OR=0.062,95%CI(0.006,0.654),P=0.021]were independent influencing factors of postoperative pregnancy.In model 2,only EFI[OR=5.395,95%CI(2.328,12.500),P<0.05]was independent influencing factor of postoperative pregnancy.The AUC of EFI score[AUC=0.937,95%CI(0.873,1.000),P<0.05]and model 2[AUC=0.949,95%CI(0.890,1.000),P<0.05]were significantly higher than those of model 1[AUC=0.856,95%CI(0.758,0.954),P<0.05].There was no difference in AUC between EFI score and model 2.Conclusions:Infertility duration,bilateral cysts,rAFS stageⅢand EFI are independent influencing factors of postoperative pregnancy in the patients with ovarian endometriosis cysts.Although the EFI score is insufficient,it is still the most ideal indicator for postoperative pregnancy assessment.
作者
杨露
韩洁
刘香菊
吴静
许冬蕾
勾明月
赵艳红
孙佩佩
高建宏
YANG Lu;HAN Jie;LIU Xiang-ju;WU Jing;XU Dong-lei;GOU Ming-yue;ZHAO Yan-hong;SUN Pei-pei;GAO Jian-hong(Department of Gynecology,Langfang People’s Hospital,Langfang 065000;Sanhe Yanjiao 23 Hospital,Langfang 065000)
出处
《生殖医学杂志》
CAS
2023年第6期836-841,共6页
Journal of Reproductive Medicine
基金
廊坊市科技支撑计划项目(2021013018)。
