| Objective:The clinical data of patients with ovarian endometriosis treated by laparoscopy were collected,and their clinical features,surgical manifestations,postoperative treatment and postoperative natural pregnancy were analyzed,and the factors affecting postoperative natural pregnancy in patients with OMA were discussed,and the treatment strategy was improved according to its influencing factors,so as to improve the postoperative pregnancy rate.Methods:The clinical data of patients with ovarian endometriosis diagnosed by laparoscopy in Dalian Maternity and Child Health Hospital from January 2017 to June2019 were collected and analyzed retrospectively.At 12-month postoperative follow-up,enrolled patients were divided into two groups(pregnant group,nonpregnant group)according to whether they conceived naturally or not.Statistics of patients’ age,body mass index(BMI),medical history,operator,mode of operation,unilateral and bilateral lesions,single multilocular lesions,size of lesions,stage of endometriosis(r-AFS stage),minimum function score((LF)),fertility index(EFI)score of endometriosis.Follow-up information such as whether gonadotropin-releasing hormone agonist(Gn RH-a)was used and the treatment cycle,whether the pregnancy was natural and the time of pregnancy after operation.Univariate analysis and multivariate Logistic regression analysis were used to analyze the related factors that may affect postoperative natural pregnancy in patients with ovarian endometriosis.Results: 1.179 patients,of whom 4 received assisted reproductive technology within 12 months after operation,and the remaining 175 patients,including 91 cases of natural pregnancy within 12 months after operation,with a natural pregnancy rate of 52.00%;131 cases of non-infertility,the natural pregnancy rate was 56.49%(74/131);44 cases of infertility were associated with infertility,and the natural pregnancy rate was 38.64%(17/44)..2.The results of univariate analysis showed that age,infertility,unilateral and bilateral cysts and single polylocular cysts were the main factors affecting the outcome of postoperative natural pregnancy in patients with ovarian endometriosis(P < 0.05).The pregnancy rate of cyst multilocular was lower than that of single chamber(39.34% VS58.77%);BMI,serum CA125 level,previous pregnancy history,cyst size,endometrial disease,fallopian tube disease,adenomyosis,r-AFS stage had no effect on the outcome of postoperative pregnancy(P > 0.05).3.The results of univariate analysis of infertility-related factors in 44 patients with OMA complicated with infertility showed that age and EFI score were the main factors affecting the outcome of natural pregnancy after operation in patients with ovarian endometriosis with infertility.4.The results of multivariate Logistic regression analysis showed that age and unilateral and bilateral cysts were independent influencing factors of natural pregnancy,in which the probability of natural pregnancy decreased by 11.50% with the increase of one year of age(OR=0.885,P < 0.05),and the probability of pregnancy on both sides of the lesion was 48.20% lower than that of unilateral focus(OR=0.605,P < 0.05).Conclusion:1.OMA has a higher natural pregnancy rate after laparoscopic surgery,and patients with infertility can also get a higher natural pregnancy rate.2.Age,infertility,unilateral and bilateral cysts and single multilocular cysts are the main factors affecting the outcome of postoperative natural pregnancy in patients with endometriosis.With the increase of age,the pregnancy rate decreased.For patients with preoperative infertility,bilateral lesions and multilocular lesions,the postoperative pregnancy rate is low.3.For the patients with OMA complicated with infertility,we should pay attention to the condition of endometrium and fallopian tube at the same time,and the natural pregnancy can be predicted according to EFI score combined with age after operation.4.For patients with endometriosis with fertility requirements,the possibility of postoperative natural pregnancy should be considered from many aspects.We should not give up the opportunity to look forward to natural pregnancy because of large cysts and high stages of endometriosis.Personalized fertility guidance should be given according to the patient’s own situation. |
PDF Full Text Request