불임을 동반한 중증 자궁내막증 환자에서 수술 후 임신에 미치는 요인에 관한 연구
The factors influencing pregnancy after surgery in infertile patients with severe endometriosis
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목적: 자궁내막증과 불임과의 정확한 상관관계는 밝혀지지 않았으나, 중증 자궁내막증을 가진 여성에서 수술이후 임신에 미치는 요인에 대해 알아보고자 한다. 연구 방법: 1995년 1월부터 2002년 12월까지 8년 동안 본 산부인과에 불임을 주소로 내원하여 수술 후 조직검사로 중증 자궁내막증으로 확진된 환자 78명을 대상으로 후향적으로 연구를 시행하였다. 모든 환자는 수술 후 6개월간 GnRHa를 사용하였다. 환자는 임신군 (n=43, 55.1%)과 비임신군 (n=35, 44.9%)으로 나누어 각 군 간의 나이, 신체질량지수 (BMI), 불임기간, 자궁내막증의 단계, 자궁내막종의 크기 및 개수, 자궁내막증의 복강 내로 전파 여부, 난관 및 난소 유착 유무, 더글라스와의 폐쇄 유무에 따라 임신율을 비교하였다. 결과: 각 요인들 중, 불임기간 (p=0.03), 자궁내막증의 복강 내로 전파 (p=0.01), 난관 유착 (p=0.04) 및 난소 유착 (p=0.02)이 임신에 영향을 미치는 것으로 나타났다. 그 외, 자궁내막종의 크기 및 개수, 자궁내막증의 단계, 더글라스와의 폐쇄 등은 영향을 미치지 않는 것으로 나타났다. 결론: 증증 자궁내막증을 가진 여성에서 수술이후 임신에 영향을 미치는 요인으로 난관과 난소의 유착 및 복강내 자궁내막증의 전파 등이 있으며, 수술 전의 불임의 기간과도 상관관계가 있는 것을 알 수 있다.
Abstract
Objective: Endometriosis is assumed to be one of the causes of infertility, although the mechanism remains unclear. The purpose of this study was to determine the prognostic factors for the fertility in women with severe endometriosis. Methods: Clinical data of 78 consecutive infertile patients who had taken surgery for stage III and IV endometriosis were retrospectively analyzed in two groups: A- pregnant after surgery (n=43, 55.1%): B- non-pregnant after surgery (n=35, 44.9%). All patients were treated with GnRHa after surgery. Each group were compared age, BMI, duration of infertility, stage of endometriosis, size and number of endometrioma, peritoneal implant outside the pelvic cavity, peritubal adhesion, ovarian adhesion and cul-de-sac obliteration. Results: Among these factors, duration of infertility (p=0.03), peritoneal implant (p=0.01), tubal adhesion (p=0.04) and ovarian adhesion (p=0.02) were significantly different. However, patients’ age, BMI, size and number of endometrioma, cul-de-sac obliteration and stage of endometriosis did not showed significantly different. Conclusion: We concluded that the duration of infertility and tubal and ovarian adhesion are important factors for predicting pregnancy after surgery in severe endometriosis.
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