Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis.
Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis.
复制标题
DOI：
10.1186/s12905-022-01666-5
复制
发表时间：
2022-03-21
期刊：
影响因子：
--
通讯作者：
Hua K
中科院分区：
文献类型：
--
作者：
Zhang N;Sun S;Zheng Y;Yi X;Qiu J;Zhang X;Zhang Y;Hua K
本研究旨在总结分析深浸润性子宫内膜异位症（DIE）的临床特点及术后生殖结局。本回顾性队列研究纳入了2009年1月至2017年6月在复旦大学妇产医院诊断为DIE、希望怀孕并接受手术切除的55例育龄患者。那些有任何可能的不孕因素或伴侣精液分析异常的人被排除在外。随访记录患者特征、术前症状、不孕症病史、术中发现及生殖结局。通过单变量logistic回归，确定了怀孕妇女与未怀孕妇女生殖结局的危险因素。此外，采用子宫内膜异位症术前和术后健康问卷-30 （ebp -30）、Knowles-Eccersley-Scott症状问卷（KESS）、Cox月经症状量表（CMSS）和女性性功能指数（FSFI）评分来评估DIE手术对生活质量的影响。平均年龄30.22±3.62岁，妊娠组与非妊娠组无统计学差异。平均随访26.57±14.51个月。34例（61.82%），其中自然妊娠24例（70.59%），体外受精10例（29.41%）。足月分娩28例（82.35%）。手术至妊娠间隔10.33±5.6（1-26）个月。单因素分析显示，较低的子宫内膜异位症生育指数（EFI）评分（EFI < 8）是不孕的危险因素（OR: 3.17 (1.15-10.14), p = 0.044）。对于手术不完全患者，术后给予促性腺激素释放激素激动剂（GnRHa）可提高妊娠率（p < 0.05）。生活质量方面，两组患者术后EHP-30、KESS、CMSS评分较术前均有显著改善（p < 0.05）。两组间FSFI评分虽无明显差异，但性交困难明显改善（p < 0.05）。总体而言，死亡患者术后妊娠率为61.82%。有疼痛主诉和妊娠意图的患者死亡的手术处理是可行和有效的。EFI评分较低（EFI < 8）的患者不建议长期期待治疗，术后IVF-ET可能是一个不错的选择。需要更多的病例进行进一步的研究，并且需要随机研究。
This study aimed to summarize and analyze clinical characteristics and reproductive outcomes in postoperative deep infiltrating endometriosis (DIE). This retrospective cohort study included 55 reproductive-aged patients who were diagnosed with DIE, wished to conceive and underwent resection surgery at the Obstetrics and Gynecology Hospital, Fudan University, from January 2009–June 2017. Those with any plausible infertility factor or abnormalities in the partner’s semen analysis were excluded. Patient characteristics, preoperative symptoms, infertility history, intraoperative findings and reproductive outcomes were followed up and recorded. Risk factors for reproductive outcomes were identified for women who became pregnant versus those who did not by univariate logistic regression. Additionally, pre- and postoperative endometriosis health profile questionnaire-30 (EHP-30), Knowles–Eccersley–Scott Symptom questionnaire (KESS), Cox Menstrual Symptom Scale (CMSS) and Female Sexual Function Index (FSFI) scores were used to evaluate the effect of DIE surgery on quality of life. The average age was 30.22 ± 3.62 years, with no difference between the pregnancy and nonpregnancy groups. The average follow-up time was 26.57 ± 14.51 months. There were 34 pregnancies (61.82%): 24 (70.59%) conceived spontaneously and 10 (29.41%) by in vitro fertilization (IVF). Twenty-eight patients (82.35%) had term deliveries. The interval between operation and pregnancy was 10.33 ± 5.6 (1–26) months. Univariate analysis showed that a lower endometriosis fertility index (EFI) score (EFI < 8) was a risk factor for infertility (OR: 3.17 (1.15–10.14), p = .044). For patients with incomplete surgery, postoperative gonadotropin-releasing hormone agonist (GnRHa) administration improved the pregnancy rate (p < 0.05). Regarding quality of life, there was significant improvement (p < 0.05) in the postoperative EHP-30, KESS and CMSS scores compared with preoperative scores in both groups. Although there was no obvious difference in FSFI scores, significant improvement in dyspareunia was observed (p < 0.05). Overall, the postoperative pregnancy rate of DIE patients was 61.82%. Surgical management of DIE for patients with complaints of pain and with pregnancy intentions was feasible and effective. Long-term expectant treatment should not be advised for patients with lower EFI scores (EFI < 8), and postoperative IVF–ET may be a good choice. More cases should be enrolled for further study, and randomized studies are required.
登录
查看更多内容
影响因子：
6.1
作者：
Johnson, Neil P.;Hummelshoj, Lone
通讯作者：
Hummelshoj, Lone
影响因子：
2.6
作者：
Berlanda N;Alio W;Angioni S;Bergamini V;Bonin C;Boracchi P;Candiani M;Centini G;D'Alterio MN;Del Forno S;Donati A;Dridi D;Incandela D;Lazzeri L;Maiorana A;Mattei A;Ottolina J;Orenti A;Perandini A;Perelli F;Piacenti I;Pino I;Porpora MG;Scaramuzzino S;Seracchioli R;Solima E;Somigliana E;Venturella R;Vercellini P;Viganò P;Vignali M;Zullo F;Zupi E;Endometriosis Treatment Italian Club (ETIC)
通讯作者：
Endometriosis Treatment Italian Club (ETIC)
影响因子：
4.1
作者：
Breteau, Pauline;Chanavaz-Lacheray, Isabella;Roman, Horace
通讯作者：
Roman, Horace
影响因子：
6.1
作者：
Dunselman, G. A. J.;Vermeulen, N.;Nelen, W.
通讯作者：
Nelen, W.
影响因子：
1.8
作者：
Gallagher, Jenny Sadler;Missmer, Stacey A.;DiVasta, Amy D.
通讯作者：
DiVasta, Amy D.