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郭醫成大共創生機 海芙刀無創助受孕

【記者湯皓宇/臺南採訪報導】39歲的洪小姐多年來因為劇烈經痛就醫,雖藉腹腔鏡手術切除雙側卵巢子宮內膜異位症引起的巧克力囊腫,卵巢存量指標抗穆勒氏管賀爾蒙(AMH)的濃度自手術前 2.9 ng/dL,術後下降到1.03,再經過三年後甚至低至0.18。儘管接受四次試管嬰兒的療程,不僅取卵的顆數減少,胚胎植入後都無法順利懷孕。這期間子宮內膜異位症更加嚴重伴隨子宮腺肌症以及深度浸潤到影響腎臟泌尿系統,導致輸尿管阻塞。雖然第五次取卵手術順利取得4顆卵子,受精後2顆囊胚期胚胎冷凍,子宮內膜異位症的指標CA-125由術前大於1000,術後幾年來停頓在200-300之間。後來順利雙胞胎懷孕。在妊娠35周時因為前置胎盤合併產前出血、胎位不正,經由剖腹手術順利生產。

▲39歲的洪小姐多年來因為劇烈經痛就醫,後來經由剖腹手術順利生產。(圖/記者湯皓宇翻攝)

腹腔鏡手術是治療子宮內膜異位症的標準流程,但是手術時應在清除病灶與保留卵巢功能之間取得平衡,因為手術過程中會傷害卵巢組織,術後AMH的數值下降,會影響未來受孕成功的機會。AMH檢測數值可以推估「生育密碼」,一般來說正常生育年齡的女性數值約在2~6 ng/dL之間,如果AMH的數值過低,代表卵子庫存量不足,受孕成功的機會就會降低,甚至提早進入更年期。子宮內膜異位症甚至深度浸潤會伴隨腺肌症,因為靠近子宮內膜的內側子宮肌肉層蠕動波增強,尤其是位於子宮後壁以及範圍較大的病灶會影響胚胎著床。由於子宮腺肌症是廣泛散佈在子宮肌肉層中,手術不容易清除完全,建議先選擇內科療法保留子宮,其次考慮外科減積手術,但是手術處理後懷孕需要擔心子宮破裂的風險。

▲子宮腺肌症與不孕症的相關性十分複雜,嚴重影響整個懷孕的過程。(圖/記者湯皓宇翻攝)

當子宮腺肌症的患者一直無法順利懷孕時,建議考慮直接接受試管嬰兒人工輔助生殖技術。經由卵巢刺激療程取卵受精後冷凍胚胎,配合藥物治療,追蹤CA-125到達適合的數值後植入解凍的胚胎。也可以配合手術或是海芙刀的輔助減少病兆組織,改善子宮內膜的容受性。宮腺肌症與不孕症的相關性十分複雜,嚴重影響整個懷孕的過程,因此如果有生育計畫,無法順利自然受孕,建議與醫師共同討論符合自身需求的個別化治療方式,一定早日成功好「孕」到!

湯 皓宇

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