Study Of The Pregnancy Rate And Related Factors Of Endometriosis After Laparoscopic Surgery

Background:Endometriosis is a common gynecological disease in reproductive age women.Endometriosis is closely related to infertility,the incidence of endometriosis in women of childbearing age is 10%~15%,as high as 30%-40% with infertility.Endometriosis caused by ovulation disorders,chronic pelvic pain,changes in the pelvic microenvironment,tubal adhesions and other serious impact on women’s fertility,to bring great mental burden on patients.Because most of the patients are women of childbearing age,have fertility requirements,so that the patient as soon as possible after the pregnancy is the fundamental purpose of treatment.The decline in pregnancy induced by endometriosis has been raised from health problems to social problems.The current gold standard for clinical treatment of endometriosis laparoscopic surgery,diagnosis and treatment of endometriosis patients with infertility is a comprehensive treatment of laparoscopic surgery in the treatment and postoperative medication or assisted reproductive technology.Laparoscopic surgery can clear the patient’s condition,effectively remove the lesion,as far as possible to reduce the patient’s injury,retain the patient’s reproductive function,but the postoperative pregnancy rate is still not satisfactory.This subject to comprehensive treatment of endometriosis patients,determine the different stage,can improve the pregnancy rate of different disease status,so as to guide the clinical treatment,to find the most appropriate treatment of patients.Objective :Through the comprehensive treatment and related factors of fertility requirements of patients with endometriosis undergoing laparoscopic surgery and postoperative analysis of postoperative pregnancy rate,in order to clinically because of endometriosis and infertility patients to provide appropriate treatment plan.Research method:In the Yancheng Maternal and Child Health-Care Hospital and The First Hospital Affiliated to Suzhou University ethics committee approval,review in 2012 01 months ~2015 year in December in Yancheng Maternal and Child Health-Care Hospital and The First Hospital Affiliated to Suzhou University preoperative diagnosis of endometriosis or intraoperative findings for endometriosis and fertility requirements of patients with a total of 242 cases were included in this study,the statistical analysis of the clinical features and operation,including age characteristics,the American Society for reproductive medicine endometriosis stage(r-AFS),endometriosis fertility score(EFI),distribution of lesions(ovarian,peritoneal,deep infiltrating type),type of infertility,infertility,dysmenorrhea,previous history of pelvic surgery,postoperative GnRH-a and whether or not to accept the pregnancy.Pregnancy after out-patient review and telephone follow-up after operation,through single factor and Logis Tic multivariate regression analysis of factors influencing the postoperative pregnancy in patients with endometriosis.Results:1.The age span of 25~38 years old were enrolled in the study,the average age(30.94 + 3.65)years;body mass index(20.16~24.63)kg/m2,the mean body mass index was(22.48 ± 1.96)kg/m2;unilateral ovarian lesions and bilateral ovarian lesions were 106 cases(43.80%)and 136 cases(56.20%);r-AFS stage I 66 cases(27.27%),stage II 65 cases(26.86%),stage III 56 cases(23.14%),stage IV 55 cases(22.73%);the EFI score(1~10),the average score was(5.14± 2.25);the distribution characteristics of ovarian lesions in 141 cases(58.26%),peritoneal type 64 cases(26.45%),deep infiltration type was 37 cases(15.29%);infertility(2~6)years,average age was(3.19 ± 2.65)years;primary infertility in 144 cases(59.50%);secondary infertility;98 cases(40.50%)complicated with severe dysmenorrhea in 201 cases(83.06%);There were 115 cases(47.52%)patients had a previous history of pelvic surgery;postoperative patients including 110 cases(45.45%)treated with GnRH-a;of which there were 62(25.62%)patients receiving assisted reproduction.2.A total of 153 patients were enrolled in the study(63.22%)successful pregnancy,6 months after operation in 23 cases of pregnancy(9.50%),65 cases of postoperative 6~12 months(26.86% months),53 cases of 12~18 after operation(21.90%),after 18~24 months of pregnancy in 12 cases(4.96%),a higher rate of 6~12 months pregnancy after operation(P<0.05),after 6 months of pregnancy and after 18~24 months of pregnancy did not differ(P>0.05).3.Univariate analysis showed that patients with endometriosis age,r-AFS stage,EFI,infertility,infertility type and postoperative GnRH-a treatment were the factors affecting the pregnancy after surgery(P<0.05),body mass index,and the factors affecting the distribution of lesions and pathological type,dysmenorrhea,previous pelvic surgery,postoperative assisted reproduction no postoperative pregnancy(P>0.05).4.Logistic regression analysis of age,r-AFS stage,EFI,duration of infertility,type of infertility,postoperative GnRH-a treatment were the independent factors affecting the postoperative pregnancy in patients with endometriosis(P<0.05).Conclusions:1.Laparoscopic surgery is the gold standard for the treatment of endometriosis,can understand the situation in the pelvic cavity and to a certain extent,solve some of the patients in the pelvic cavity may affect the factors of pregnancy.2.Laparoscopy combined with drug therapy can improve the pregnancy rate of patients with endometriosis and infertility in two years.3.With the increase of age,r-AFS stage,the increase in the number of years of infertility and primary infertility can reduce the probability of postoperative pregnancy.4.EFI and postoperative GnRH-a treatment can improve the postoperative pregnancy rate in patients with endometriosis and infertility.With the increase of EFI and postoperative GnRH-a treatment can improve the probability of postoperative pregnancy.