桂枝茯苓丸治疗子宫内膜异位症保守手术后的临床研究

发布时间：2018-06-13 08:33

本文选题：子宫内膜异位症 + 保守手术后　；参考：《河北大学》2017年硕士论文

【摘要】：目的通过观察子宫内膜异位症保守手术后的患者应用中成药桂枝茯苓丸巩固治疗与术后应用西药促性腺激素释放激素激动剂(GnRH-a)巩固治疗的患者,在临床症状、疗效、复发情况及药物不良反应上的优劣,研究桂枝茯苓丸治疗子宫内膜异位症保守手术后的临床优势。方法选取2015年1月至2016年9月,河北大学附属医院收治的首次开腹或腹腔镜保守手术,且经术后病理证实为子宫内膜异位症的患者共60例。采取随机法,将术后患者随机分为中药组(30例)、西药组(30例);另外选取子宫内膜异位症保守手术后,向患者建议应用药物巩固治疗,但拒绝应用并签字者作为对照组(30例)。中药组术后给与口服中成药“桂枝茯苓丸”,6g/次,2次/日,治疗3个月(经期及经后3天停用);西药组给与GnRH-a:皮下注射“醋酸亮丙瑞林”3.75mg/次,1次/28天,治疗3个疗程;对照组术后拒绝应用任何药物巩固治疗。比较三组患者在术后痛经评分改变、血清CA125降低情况、临床疗效、复发情况及药物不良反应上的差异。结果术后3个月的痛经评分程度(中药组轻度5例,中度3例,重度0例;西药组轻度5例,中度1例,重度0例;对照组轻度9例,中度6例,重度0例),无统计学差异(P0.05)。但术后半年的痛经评分程度(中药组轻度6例,中度3例,重度0例;西药组轻度5例,中度1例,重度0例;对照组轻度12例,中度6例,重度0例),存在统计学差异(P0.05)。术后3个月的血清CA125的降低例数(中药组为28例,西药组为29例,对照组25例),无统计学差异(P0.05)。术后半年的血清CA125的降低例数(中药组为26例,西药组为28例,对照组21例),存在统计学差异(P0.05)。术后3个月中医组的有效率(66.67%)、缓解率(33.33%)、复发率(0.00%),西医组的有效率(76.67%)、缓解率(23.33%)、复发率(0.00%),对照组的有效率(66.67%)、缓解率(30.00%)、复发率(3.33%),无统计学差异(P0.05)。术后半年中医组的有效率(73.33%)、缓解率(23.33%)、复发率(3.33%),西医组的有效率(80.00%)、缓解率(20.00%)、复发率(0.00%),对照组的有效率(56.67%)、缓解率(26.67%)、复发率(16.67%),存在统计学差异(P0.05)。在药物不良反应方面,其中在肝肾功能损害上中药组(4例)、西药组(5例)、对照组(0例)无统计学差异(P0.05),但中药组及对照组在潮热、闭经及阴道出血的发生例数上明显低于西药组(中药组分别为8例、4例、7例,西药组分别为15例、11例、16例,对照组分别为5例、3例、8例),结果均存在统计学上差异(P0.05)。结论子宫内膜异位症保守手术后进一步给予桂枝茯苓丸巩固治疗的患者与术后给予醋酸亮丙瑞林巩固治疗的患者,在痛经评分的变化、血清CA125降低情况、临床疗效上均无明显差异,但是均明显优于未给予巩固治疗者,表明子宫内膜异位症保守术后进一步给予桂枝茯苓丸巩固治疗后的患者自觉症状、化验指标、临床有效率及术后复发率上均有较好的效果,且与术后应用醋酸亮丙瑞林巩固治疗无明显差异;但应用桂枝茯苓丸进行巩固治疗的药物不良反应的发生率明显低于应用醋酸亮丙瑞林进行巩固治疗,尤其是明显降低了患者术后出现潮热、闭经及阴道出血的发生率,说明桂枝茯苓丸在子宫内膜异位症保守术后的巩固治疗上存在优势,值得进行临床推广。
[Abstract]:Objective To observe the clinical symptoms, curative effect, recurrence and adverse drug reaction in patients with the consolidation therapy of Guizhi Fuling pill (Guizhi Fuling pill) after the conservative operation of endometriosis after the conservative operation of the Chinese patent medicine Guizhi Fuling pill (GnRH-a), and to study the treatment of cinnamon tuckahoe pill in the uterus. The clinical advantages of conservative surgery were selected from January 2015 to September 2016. The first laparotomy or laparoscopic conservative surgery in the Affiliated Hospital of Hebei University was selected, and 60 patients with endometriosis confirmed by postoperative pathology were randomly divided into Chinese medicine group (30 cases) and Western medicine group (30 cases). After the conservative operation of endometriosis was selected, the drug consolidation therapy was recommended to the patients, but the patients were refused and signed as the control group (30 cases). The Chinese traditional medicine group was given the Chinese traditional Chinese medicine "Guizhi Fuling pill", 6g/ times, 2 times, treatment for 3 months (menstrual and 3 days after the menstruation); the western medicine group gave the subcutaneous injection of "acetic acid bright". Proprolin "3.75mg/ times, 1 /28 days, treatment for 3 courses, the control group refused to use any drug consolidation treatment after operation. Compare the changes of dysmenorrhea score, serum CA125 reduction, clinical efficacy, recurrence and drug adverse reactions in the three groups. Results the degree of dysmenorrhea score of 3 months after the operation (5 cases of Chinese medicine group, moderate to moderate) 3 cases, severe 0 cases, western medicine group mild 5 cases, moderate 1 cases, severe 0 cases, control group 9 cases, moderate 6 cases, severe 0 cases, no statistical difference (P0.05), but the degree of dysmenorrhea score (6 in the Chinese medicine group, moderate 3, severe 0, moderate 1 cases, moderate serious 0 cases in the western medicine group, mild cases in the control group, moderate cases, severe cases), Statistical difference (P0.05). The number of serum CA125 decreased in 3 months after operation (28 cases in Chinese medicine group, 29 in western medicine group and 25 in control group). There was no statistical difference (P0.05). There were 26 cases of serum CA125 in six months after operation (26 cases of traditional Chinese medicine group, 28 cases in western medicine group and 21 cases in control group), and there were statistical differences (P0.05). The effectiveness of traditional Chinese medicine group was effective 3 months after operation. Rate (66.67%), remission rate (33.33%), recurrence rate (0%), the effective rate (76.67%), remission rate (23.33%), recurrence rate (0%), the efficiency (66.67%) of the control group (66.67%), the remission rate (30%), the recurrence rate (3.33%), and no statistical difference (P0.05). The effective rate (73.33%), relapse rate (23.33%), recurrence rate (3.33%), and the effectiveness of Western medicine group were effective six months after the operation. Rate (80%), the rate of remission (20%), the rate of recurrence (0%), the efficiency of the control group (56.67%), the remission rate (26.67%), the recurrence rate (16.67%), and there was a statistical difference (P0.05). In the adverse drug reactions, the liver and kidney function damage in the Chinese medicine group (4 cases), the western medicine group (5 cases), and the control group (0 cases) had no statistical difference (P0.05), but the traditional Chinese medicine group and the control group were in the control group (0 cases). The number of cases of tidal fever, amenorrhea and vaginal bleeding were significantly lower than that of the western medicine group (8 cases, 4 cases, 7 cases respectively, 15 cases in the western medicine group, 11 cases, 16 cases respectively, 5 cases, 3 cases, 8 cases respectively), and the results were statistically different (P0.05). Conclusion after conservative operation of endometriosis, it was further given the consolidation therapy of Guizhi Fuling pill. There was no significant difference in the clinical efficacy between the patients and the patients who had been treated with bright propane acetate, the changes in the dysmenorrhea score, the decrease in the serum CA125 and the clinical efficacy, but all of them were obviously better than those without the consolidation therapy. The test index, clinical efficiency and postoperative recurrence rate have good results, and there is no significant difference with the postoperative application of Leucin acetate consolidation therapy. However, the incidence of adverse drug reactions with cinnamon Fuling pill for consolidation therapy is obviously lower than that of bright propane acetate. The incidence of hot flashes, amenorrhea and vaginal bleeding shows that Guizhi Fuling pill has advantages in the consolidation of endometriosis after conservative surgery. It is worthy of clinical promotion.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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