补肾祛瘀法联合GnRH-a治疗子宫内膜异位症（腹腔镜术后）的疗效分析

发布时间：2018-05-16 08:21

本文选题：补肾祛瘀法 + 子宫内膜异位症术后　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的观察补肾祛瘀法联合GnRH-a治疗内异症腹腔镜术后患者治疗前后肾、血瘀的积分和分级的改变情况,以及治疗后1年内的复发情况、受孕情况,明确补肾祛瘀法联合GnRH-a治疗内异症腹腔镜术后患者的临床疗效。方法选取2014年12月～2016年1月就诊我院妇科病房住院的内异症腹腔镜术后应用GnRH-a有生育要求的肾虚血瘀证患者为研究对象,随机分为中药组、对照组,每组各30例。两组均于术后月经来潮第1天开始注射醋酸亮丙瑞林,每28天一针,共三针。中药组在每次注射醋酸亮丙瑞林后第1天起服用补肾祛瘀方,连服21天为一个疗程,共3个疗程。对照组不予其他处理,若患者血管舒缩综合征症状明显,予谷维素口服,一次1片,一日3次。于注射第3针后的28天进行疗效评估,观察两组患者治疗前后肾、血瘀积分及分级的改变情况。随访观察两组患者治疗后不同时期的B超检查结果、VAS评分表、血清CA125水平以及患者治疗后1年内的复发情况、受孕情况,并运用统计软件对数据进行统计学处理,分析比较两种疗法对内异症腹腔镜术后应用GnRH-a治疗的临床疗效差异。结果1.两组患者在治疗后半年内B超复发情况差异无统计学意义(P0.05);中药组患者治疗后一年内B超复发率低于对照组,差异有统计学意义(P0.05)。2.两组患者于治疗后半年痛经、盆腔痛、性交痛的VAS评分情况差异无统计学意义(P0.05);中药组在治疗后一年痛经、盆腔痛、性交痛的VAS评分情况均明显低于对照组,差异有显著的统计学意义(P0.01)。3.两组患者于注射第3针亮丙瑞林后的28天的血清CA125水平差异无统计学意义(P0.05);中药组在治疗后半年、治疗后一年血清CA125水平明显低于对照组,差异有显著的统计学意义(P0.01)。4.中药组患者治疗后一年内复发率低于对照组,差异有统计学意义(P0.05)。5.中药组患者治疗后一年内受孕率高于对照组,差异有统计学意义(P0.05)。6.两组患者在治疗前肾、血瘀积分情况差异无统计学意义(P0.05)。经过治疗后,中药组肾、血瘀积分和分级均较治疗前明显降低,且疗效明显优于对照组(P0.01);而对照组经过治疗后肾积分和分级较治疗前明显升高,血瘀积分和分级与治疗前对比相对降低。结论1补肾祛瘀法能够缓解内异症患者痛经、盆腔痛、性交痛的疼痛程度;2补肾祛瘀法可在一定程度上降低血清CA125水平和B超复发率,从而减少内异症的复发;3补肾祛瘀法在一定程度上可以改善内异症患者的受孕率,提高生育能力;4补肾祛瘀法可降低内异症腹腔镜术后应用GnRH-a的肾、血瘀积分和分级,增强患者对GnRH-a的耐受性。
[Abstract]:Objective to observe the changes of renal and blood stasis score and grade before and after treatment with GnRH-a combined with tonifying the kidney and removing blood stasis in patients with endoscopes after laparoscopic surgery, as well as the recurrence and pregnancy in one year after treatment. To determine the clinical efficacy of tonifying kidney and removing blood stasis combined with GnRH-a in patients with endodysm after laparoscopic surgery. Methods from December 2014 to January 2016, patients with kidney deficiency and blood stasis syndrome with GnRH-a were randomly divided into Chinese medicine group (n = 30) and control group (n = 30). On the first day of menstrual onset, the two groups received three injections of Leuprilline Acetate every 28 days. The traditional Chinese medicine group took Bushen Quyu decoction on the first day after each injection of Leuprorelin Acetate, taking 21 days as a course of treatment for 3 courses. In the control group, if the symptoms of vasomotor syndrome were obvious, oryzanol was given orally, 1 tablet once, 3 times a day. The curative effect was evaluated 28 days after the third injection, and the changes of kidney, blood stasis score and grading were observed before and after treatment. The results of B-ultrasound examination in different periods after treatment were followed up. The scores of VAS, the level of serum CA125, the recurrence of the patients within one year after treatment, and the conception of the patients were observed. The data were analyzed by statistical software. To analyze and compare the clinical curative effect of two kinds of therapy in treating endoscopes after laparoscopic operation with GnRH-a. Result 1. There was no significant difference in the recurrence of B-ultrasound between the two groups within half a year after treatment, while the recurrence rate of B-ultrasound in the Chinese medicine group was lower than that in the control group within one year after treatment, and the difference was statistically significant. There was no significant difference in VAS scores of dysmenorrhea, pelvic pain and sexual intercourse pain between the two groups half a year after treatment. The VAS scores of dysmenorrhea, pelvic pain and sexual intercourse pain in the Chinese medicine group were significantly lower than those in the control group one year after treatment. The difference was statistically significant (P 0.01. 3). There was no significant difference in serum CA125 level between the two groups at 28 days after the third injection of Leurelin, but the serum CA125 level in the traditional Chinese medicine group was significantly lower than that in the control group half a year after treatment and one year after treatment, and the difference was statistically significant. The recurrence rate in the Chinese medicine group was lower than that in the control group within one year after treatment, and the difference was statistically significant (P 0.05). The pregnancy rate in the Chinese medicine group within one year after treatment was higher than that in the control group, and the difference was statistically significant (P 0.05. 6). There was no significant difference in blood stasis score between the two groups before treatment (P 0.05). After treatment, the renal blood stasis score and grade of the Chinese medicine group were significantly lower than those of the control group, and the curative effect was obviously better than that of the control group (P 0.01), while the renal score and grade in the control group were significantly higher than those before the treatment. Blood stasis score and grading were relatively lower than those before treatment. Conclusion (1) the method of tonifying kidney and removing blood stasis can relieve the pain degree of dysmenorrhea, pelvic pain and sexual intercourse pain in patients with endodonosis. The method of tonifying kidney and removing blood stasis can reduce the level of serum CA125 and the recurrence rate of B-ultrasound to a certain extent. Therefore, the method of reducing the recurrence of endometriosis and eliminating kidney and blood stasis can improve the pregnancy rate of patients with endodysm to a certain extent, and improve the fertility of patients with endometriosis. The method of tonifying kidney and removing blood stasis after laparoscopy can reduce the score and grade of kidney, blood stasis and blood stasis of GnRH-a after laparoscopy. Enhance patient's tolerance to GnRH-a.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.71

【参考文献】