The Clinical Study Of The Two Scoring Systems On Guiding The Treatment Of Using GnRHa After The Surgery Of The EAI Patients

Objective:The clinical data of the EAI patients from Zhujiang Hospital of Southern Medical University were retrospectively analyzed to compare the value of two different scoring systems(ASRM staging and Endometriosis Fertility Index)in assessing the postoperative natural pregnancy rate of EAI patients.Whether or not the EFI patients combined with GnRHa after the surgery can improve pregnancy rate after surgery to better guide the postoperative treatment,including whether postoperative GnRHa should be used in combination;whether natural pregnancy or early ART can be expected;and how long to expect natural pregnancy.Ultimately improve the pregnancy rate and pregnancy outcomes of patients with EAI.Methods:This research collected the date from January 2011 to May 2016 in Zhujiang Hospital,Southern Medical University,the 322 patients with EAI,their clinical data is completed and regular follow-up.All the patients underwent laparoscopic surgery and were confirmed as pelvic endometriosis by pathological examination.Establish a unified database,and record all patients' clinical data(including ages,maternal history,preoperative abnormality test results),surgical data(including surgical methods,and whether or not complications of ovarian endometrioma cysts,lowest functional score of LF,score of endometriotic lesions in ASRM,total score of ASRM)and follow-up condition(including types and timing of postoperative drug treatment,pregnancy patterns,the time from the end of the treatment to the end of the last menstrual period,pregnancy outcomes;statistics of the accumulated pregnancy rates of different groups after the treatment at the point of half years,1 year,2 year and 3 year.Results:1.There was a significant difference between postoperative ART pregnancy rat and the natural pregnancy rate of the operation group after the surgery(P<0.05).For the combined therapy group,there was no significant difference between the ART pregnancy rate and the natural pregnancy rate after the drug treatment(P>0.05).2.In the operation group,the natural pregnancy rate of mild EMT was 48.00%,and the natural pregnancy rate of moderate to severe was 20.00%.There was significant difference between the two groups(P<0.05).In the combined therapy group,the natural pregnancy rate of mild EMT was 60.36%,and moderate to severe was 49.45%.There was no significant difference between the two(P>0.05).3.For mild EMT,the accumulative pregnancy rate in the combined group was higher than that in the operation group,and the difference was statistically significant(P<0.05).For the moderate and severe EMT,the accumulative pregnancy rate between the operation group and the combined group was statistically different at the four corresponding time points within 3 years.The growth rate of pregnancy rate reached the maximum for each group at six months after the end of treatment,and then the growth rate of pregnancy showed a downward trend.The pregnancy rates within 1 year after the end of the treatment of the two groups were approximately 50%of the total pregnancy rate within 3 years.4.There was no significant difference in adverse pregnancy outcomes between the operation group and the combined therapy group.5.The higher the EFI score,the higher the accumulative PR.The 3-year cumulative natural PRs of the EFI scores of 0-2,2-4,5-6,7-8 and 9-10 were 7.14%,24.44%,39.08%,62.62%,79.31%,respectively,and were statistically significant.6.The EFI scores of 5-8 points in the group,the combined group accumulative natural PR was significantly higher than the operation group and there were statistically significant difference(P<0.05),while were not for the EFI scores of 0-4 and 9-10 group.7.For the patients in the operation group and the combined therapy group,the growth rate of the PR was the highest in the six months.And the overall growth rate showed a downward trend afterwards;For the 5-8 group,the pregnancy rate reached the maximum at 1 year after treatment in the operation group,but the PR still increased slowly in the combined therapy group.8.Patients turning to the ART had higher PRs despite the different EFI scores,with no significant difference between the groups(P>0.05).Conclusion:1.The combination use of GnRHa after surgery does not improve the PR of patients with mild EMT,but it can significantly improve the PR of patients with moderate to severe EMT;2.The half year after the treatment of the operation group and the combined therapy group is a "golden period" for pregnancy.The accumulative PR within one year may reach the 50%of the following 3 years.3.The EFI index can better predict the natural PR after surgery.The EAI patients with the higher EFI score can expect for a longer time for natuaral pregnancy.Patients with low EFI scores should reduce expectant time and turn to ART as soon as possible.4.For patients with a score of 5-8,it is advisable to use GnRHa in combination postoperatively and to extend the expectation time appropriately.