目的 分析子宫内膜异位症伴不孕患者腹腔镜手术治疗后对术后妊娠的影响.方法 114例子宫内膜异位症伴不孕患者, 对其进行腹腔镜下异位电凝术、粘连分离术、卵巢子宫内膜异位囊肿剥离手术以及术后联合人工辅助生育技术等, 并进行综合分析评价.结果 114例患者, 经手术后病灶通过腹腔镜下检测, 蓝色异位病灶87例, 红色异位病灶79例, 腹膜皱缩23例, 盆腔积液19例, 一侧或双侧输卵管伞端闭锁27例.对异位病灶进行电凝术106例, 卵巢子宫内膜异位囊肿切除54例, 输卵管伞端成形造口27例.手术后, 根据患者的不同情况进行监测排卵或人工受精、体外受精-胚胎移植来实现妊娠.随访追踪自然妊娠57例, 妊娠率50.00%, 异位复发9例, 复发率15.79%;手术后促排卵治疗67例, 妊娠45例, 妊娠率67.16%, 异位复发13例, 复发率19.40%;术后联合人工辅助生殖技术10例, 妊娠8例, 妊娠率80.00%, 异位复发3例, 复发率30.00%.促排卵治疗和自然妊娠两种方法的妊娠率比较差异有统计学意义(P0.05).结论 腹腔镜手术诊断子宫内膜异位症伴不孕的患者, 可了解不孕不育的盆腔症状, 对输卵管畅通性作出准确的评价, 并对发现的子宫内膜异位症作出治疗, 经手术治疗后, 其不孕不育患者的妊娠率有所提升, 对复发风险无明显改善.%Objective To analyze influence by laparoscopic surgery for endometriosis complicated with infertility patients on pregnancy after operation.Methods A total of 114 endometriosis complicated with infertility patients received laparoscopic endometriosis electric coagulation, synechia separation surgery, adenomas endometrioides ovarii cyst stripping, and postoperative combination with artificial assisted reproductive technology, along with comprehensive analysis and evaluation.Results After operation, 114 patient received lesion laparoscopic detection, which showed 87 cases with blue ectopic lesions, 79 cases with red ectopic lesions, 23 cases with peritoneal shrivel, 19 cases with pelvic effusion, and 27 cases with unilateral or bilateral oviduct umbrella end closure. Electrocoagulation was applied for 106 ectopic lesions, 54 cases received adenomas endometrioides ovarii cystectomy and 27 cases received oviduct umbrella end forming colostomy. After operation, monitoring ovulation, artificial fertilization, and external fertilization-embryo transplantation were applied due to different patients' condition for pregnancy. Follow-up showed 57 natural pregnancy cases, with pregnancy rate as 50.00%, 9 recurrent ectopia cases, with recurrence rate as 15.79%. There were 67 cases received postoperative ovulation induction treatment, and 45 cases among them were pregnant, with pregnancy rate as 67.16%, and 13 cases with recurrent ectopia, with recurrence rate as 19.40%. 10 cases reiceved postoperative combination of artificial assisted reproductive technology, and 8 cases of them were pregnant, with pregnancy rate as 80.00%, 3 cases with recurrent ectopia, with recurrence rate as 30.00%. The difference of pregnancy rate had statistical significance between ovulation induction treatment and spontaneous pregnancy (P0.05).Conclusion Laparoscopic surgery can provide precise evaluation and treatment for endometriosis through diagnosing endometriosis patients, and understanding symptoms of infecund pelvic. Surgical treatment increases pregnancy rate in infertility patients, and it remarkably improves risk of recurrence.
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