目的：對於第三期及第四期子宮內膜異位症合併子宮內膜異位腫瘤接受腹腔鏡合併微小剖腹式手術治療方法及懷孕預後之評估。方法：本研究共有49 位患有第三及第四期子宮內膜異位症合併子宮內膜異位腫瘤之女性。所有病人皆於1999 年8 月至2000年7 月接受腹腔鏡併微小剖腹式手術。病患術前皆接受超音波診斷患有子宮內膜異位腫瘤，並測量腫瘤大小。手術前一週測量病患血中CA-125 值。病患於術後追蹤懷孕之預後及疾病復發率，追蹤時間長達36 個月之久。結果：有6 位病患於術後無法追蹤(12.2%)。病患(共43 個案) 平均年齡為30.3 ± 4.1 歲，其血中平均CA-125 值為72.3 ±67.7u/ml，並且有74.4%的腫瘤大於3 公分。術後追蹤期內，所有病患接受了不孕症治療共123 個週期。整體懷孕率為51.2%；12 個月及24 個月累積懷孕率各為32.5%及51.2%。腫瘤復發率為4.7%。結論：腹腔鏡合併微小剖腹式手術對於第三期及第四期子宮內膜異位症合併子宮內膜異位腫瘤的治療在追蹤了36 個月後發現可以有效的減低復發率及具有與其他手術方式相同的懷孕率。

Background and Purpose: We attempted to assess the technique and pregnancyoutcomes of combined laparoscopy and minilaparotomy for stage III and IVendometriosis with an endometrioma. Methods: In total, 49 patients with Stage III or IVendometriosis with an endometrioma were examined in this study. All patients receivedtreatment with combined laparoscopy and minilaparotomy between August 1999 andJuly 2000. Preoperative ultrasonography was performed to diagnose the endometriomaand measure the tumor size. The serum CA-125 level was checked 1 week before surgery.Patients were then inspected for pregnancy outcome and disease recurrence over a 36-month follow-up period. Results: Six patients were lost to follow-up after surgery (12.2%).The mean age of the patients (n = 43) was 30.3 ± 4.2 years. The mean serum CA-125 levelwas 72.3 ± 67.7 U/ml, and 74.4% of the tumors were larger than 3 cm in diameter. In total,123 cycles of controlled ovarian hyperstimulation were performed during the follow-upperiod. The overall pregnancy rate was 51.2% The cumulative pregnancy rates at 12 and24 months were 32.5% and 51.2%, respectively. The recurrence rate of endometriomas was4.7%. Conclusion: Combined laparoscopy and minilaparotomy for the management ofstage III and IV endometriosis with an endometrioma are effective with a low recurrencerate, and there may be a similar conception rate compared with other surgical techniquesover a 36-month follow-up period.