Objective:To evaluate the clinical value of the American Fertility Society (r-AFS) score to guide the combined medical therapy after laparoscope in the patients with severe endometriosis. Methods: We retrospectively reviewed 255 patients with endometriosis about the diagnosis, surgery, and r-AFS score obtained under laparoscope. The patients, in the stage of Ⅲ - Ⅳ, were administrated with drugs after the surgeries, and the effects of medical treatment of both short and long terms were assessed. Results: Amang these 255 patients, 65, 61,79 and 50 cases were assigned to stageⅠ,Ⅱ, Ⅲ and Ⅳ respectively according to r-AFS. Drugs were administrated to 129 patients for 3-6 months in the stage of Ⅲ - Ⅳ, while not to the patients in the stage of Ⅰ-Ⅱ. The following up of 87 patients at 1-3 years showed a complete relief of the pain in 45 cases (51.7％), effective relief of pain in 80 cases (91.9％), and partial relief ofpain in 5 cases (5.7％). Among the 87 patients, 21 cases have gestations over the 1-3 years, with the total pregnancy rate reaches 48.8％ and the recurrence rate is 14. 9％. Conclusions:Combination of medical therapy after the surgery is important for patients with endometriosis. The r-AFS scores by laparoscope have marked significance to assess the severity of the disease, to choose individual therapy, and to instruct us whether medical treatment is needed. And such combination can effectively alleviate the pelvic pain, increase the pregnancy rate, and decrease the recurrence rate for the patients in the stage of Ⅲ - Ⅳ.%目的:评价腹腔镜手术治疗子宫内膜异位症术中采用美国生殖医学协会子宫内膜异位症分期(r-AFS)评分法指导重度子宫内膜异位症术后联合药物治疗的临床价值.方法:255例子宫内膜异位症患者,在电视腹腔镜下进行诊断、手术,并行r-AFS分期,术后对Ⅲ-Ⅳ期的重度子宫内膜异位症患者行联合药物治疗,并评价近、远期的效果.结果:255例患者中r-AFS评分Ⅰ期65例、Ⅱ期61例、Ⅲ期79例、Ⅳ期50例.术后126例Ⅰ～Ⅱ期患者未行药物治疗,129例Ⅲ～Ⅳ期患者术后给予药物治疗3～6个月,术后1～3年坚持随访者87例,盆腔疼痛完全缓解45例(51.7%),有效缓解80例(91.9%),不全缓解 5例(5.7%).术后1～3年妊娠 21 例,总妊娠率为48.8%,术后3年累计复发率为14.9 %.结论:腹腔镜下r-AFS评分对子宫内膜异位症严重程度的评估、正确选择治疗方案及术后指导药物治疗有重大临床意义;对Ⅲ～Ⅳ期子宫内膜异位症患者术后联合药物治疗可以有效减轻盆腔疼痛、提高妊娠率、降低术后复发率.
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