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目的:探讨宫腹腔镜术后联合不同药物对轻、中度子宫内膜异位症(EMs)性不孕患者妊娠率的影响。方法:回顾分析2008年9月至2011年12月在我院就诊的82例Ⅱ~Ⅲ期EMs性不孕患者的临床资料,患者均行宫腹腔镜联合保留生育功能的手术。按照严格的纳入和剔除标准,筛选出有自然受孕能力的患者,术后按个人意愿用药。按患者术后用药情况分为对照组(18例)、促性腺激素释放激素激动剂组(GnRH-a,博恩诺康)(31例)和口服避孕药组(去氧孕烯炔雌醇片,妈富隆)(33例),比较3组患者在术后不同时期的妊娠率及异位妊娠的发生率。结果:博恩诺康组、妈富隆组和对照组患者术后1年内的妊娠率分别为77.42%(24/31)、51.52%(17/33)和33.33%(6/18),博恩诺康组显著高于对照组及妈富隆组(P<0.05),而后两组则无显著差异(P>0.05)。3组患者的异位妊娠率分别为3.23%(1/31)、6.06%(2/33)和5.56%(1/18),均无显著差异(P均>0.05)。术后1年内,Ⅱ期EMs患者中,3组妊娠率差异显著(P=0.020);Ⅲ期EMs患者中,3组妊娠率无显著差异(P=0.297)。Ⅱ、Ⅲ期患者中,3组的异位妊娠率均无显著差异(P>0.05)。结论:宫腹腔镜术后联合博恩诺康有利于改善轻、中度EMs性不孕患者的生育能力。
Objective: To investigate the effect of laparoscopic combined with different drugs on pregnancy rate in patients with mild to moderate endometriosis (EMs) infertility. Methods: The clinical data of 82 patients with stage Ⅱ ~ Ⅲ EMs infertility who were treated in our hospital from September 2008 to December 2011 were retrospectively analyzed. All patients underwent laparoscopic hysteroscopy combined with the operation of preserving fertility. In accordance with strict inclusion and exclusion criteria, the screening of patients with natural conception ability, according to personal wishes after treatment. The patients were divided into control group (n = 18), gonadotropin-releasing hormone agonist group (n = 31) and oral contraceptive group Film, Marvelon) (33 cases). The pregnancy rate and the incidence of ectopic pregnancy were compared between the three groups in different periods. Results: The pregnancy rates in Bonn’s group, Marvelon group and control group within one year after operation were 77.42% (24/31), 51.52% (17/33) and 33.33% (6/18) respectively, Nocturia group was significantly higher than the control group and Marvelon group (P <0.05), but there was no significant difference between the latter two groups (P> 0.05). The rates of ectopic pregnancy in the three groups were 3.23% (1/31), 6.06% (2/33) and 5.56% (1/18), respectively, with no significant difference (all P> 0.05). Within 1 year after operation, the pregnancy rates of three groups of patients with EMs were significantly different (P = 0.020). There was no significant difference in the pregnancy rates among the three groups of EMs patients (P = 0.297). There was no significant difference in the ectopic pregnancy rate between the three groups (P> 0.05). Conclusions: Postoperative hysteroscopy combined with Bonnoconazole can improve the fertility of mild to moderate EMs infertility.