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目的探讨子宫内膜异位症生育力指数(endometriosis fertility index,EFI)评分系统对子宫内膜异位症合并不孕患者的腹腔镜术后自然妊娠概率的预测价值。方法回顾性分析2008年1月至2011年12月北京大学第三医院生殖医学中心256例进行腹腔镜联合宫腔镜检查,诊断为子宫内膜异位症合并不孕症并进行EFI评分患者的临床资料,随访其术后2年的自然妊娠情况。并对患者的不同EFI得分、临床特征、术后妊娠时间及妊娠率等进行统计学分析。结果 256例患者中,230例(89.9%)完成2年的随访,其中自然妊娠128例(55.7%),其余未孕。各EFI得分组妊娠率分别为:EFI 10分组81.0%(17/21),EFI 9分组70.0%(35/50),EFI 8分组49.0%(24/49),EFI 7分组52.6%(30/57),EFI 6分组52.0%(13/25),EFI 5分组35.0%(7/20),EFI≤4分组25.0(2/8),可见随着EFI得分的升高妊娠率呈升高趋势。ROC曲线分析得出的EFI临界点为8.5分,EFI得分>8.5分者妊娠率为73.2%(52/71),得分<8.5分者妊娠率为47.8%(76/159),两组比较,差异有统计学意义(P=0.000)。术后一年内妊娠率(43.5%,100/230)与一年后妊娠率(21.5%,28/130)比较,差异有统计学意义(P=0.000)。结论子宫内膜异位症生育力指数对子宫内膜异位症合并不孕患者腹腔镜术后自然妊娠概率有一定预测价值。
Objective To investigate the predictive value of endometriosis fertility index (EFI) scoring system for the probability of spontaneous pregnancy after laparoscopic surgery in patients with endometriosis and infertility. Methods A retrospective analysis of 256 patients with reproductive medicine center of Peking University Third Hospital from January 2008 to December 2011 was performed laparoscopy combined with hysteroscopy in diagnosis of endometriosis with infertility and EFI score Clinical data were followed up for 2 years after natural pregnancy. The different EFI scores, clinical characteristics, postoperative pregnancy time and pregnancy rate were analyzed statistically. Results Among the 256 patients, 230 (89.9%) patients were followed up for 2 years, of which 128 (55.7%) were natural pregnant and the rest were not pregnant. The pregnancy rates of each EFI score group were 81.0% (17/21) in EFI 10 group, 70.0% (35/50) in EFI 9 group, 49.0% (24/49) in EFI 8 group and 52.6% (30.6% 57), 52.0% (13/25) in EFI group 6, 35.0% (7/20) in EFI group 5, and 25.0 (2/8) in EFI≤4 group. The pregnancy rate showed an increasing trend with the increase of EFI score . ROC curve analysis of the EFI cut-off point was 8.5 points, EFI score> 8.5 points were 73.2% (52/71), score <8.5 points were 47.8% (76/159) pregnancy rate, the two groups, The difference was statistically significant (P = 0.000). The pregnancy rate (43.5%, 100/230) in one year after operation was significantly different from the one-year pregnancy rate (21.5%, 28/130) (P = 0.000). Conclusion The endometriosis fertility index has certain predictive value for the probability of spontaneous pregnancy after laparoscopic surgery in patients with endometriosis complicated with infertility.