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目的:探讨卵巢子宫内膜异位囊肿合并不孕的患者术后治疗策略。方法:将腹腔镜下卵巢子宫内膜异位囊肿剥除术后要求妊娠的62例不孕患者随机分为期待组(n=31)和GnRH-a组(n=31)。期待组腹腔镜手术后随访观察,避免使用激素类药物;GnRH-a组腹腔镜手术后月经第1日给予GnRH-a治疗:达菲林3.75 mg皮下注射,1次/28 d,连用3次停药。所有患者随访24个月,观察24个月内妊娠情况。结果:期待组12个月内妊娠率为41.9%(13/31),13~24个月内妊娠率为22.2%(4/31),24个月累积妊娠率为54.8%(17/31)。GnRH-a组1年内妊娠率为48.4%(15/31),13~24个月内妊娠率为18.8%(3/31),24个月累积妊娠率为58.1%(18/31)。期待组与GnRH-a组比较,12个月内妊娠率、24个月累积妊娠率组间均无统计学差异(P>0.05)。结论:初步临床观察,卵巢子宫内膜异位囊肿剥除术后使用GnRH-a在提高EMs合并不孕患者妊娠率方面未显示出优势。
Objective: To investigate the postoperative treatment strategy of patients with ovarian endometriosis complicated with infertility. Methods: Sixty-two infertile women who underwent laparoscopic ovarian endometriosis after pregnancy were randomly divided into the expectant group (n = 31) and the GnRH-a group (n = 31). A group of GnRH-a group was given GnRH-a on the first day after menstruation: 3.75 mg of danfarin was injected subcutaneously once a day for 28 days with 3 times of stop medicine. All patients were followed up for 24 months to observe the pregnancy within 24 months. Results: The expected pregnancy rate was 41.9% (13/31) in 12 months, the pregnancy rate was 22.2% (13/31) in 13-24 months, and the cumulative pregnancy rate in 24 months was 54.8% (17/31) . The pregnancy rate was 48.4% (15/31) within 1 year in GnRH-a group, 18.8% (3/31) in 13-24 months, and 58.1% (18/31) in 24 months. Expect group compared with GnRH-a group, 12-month pregnancy rate, 24-month cumulative pregnancy rate was no significant difference between groups (P> 0.05). Conclusion: Preliminary clinical observation showed that GnRH-a did not show any advantage in improving the pregnancy rate of EMs with infertility patients after ovariectomy.