中药联合腹腔镜手术对输卵管阻塞性不孕患者血清肿瘤坏死因子α及临床疗效的影响

发布时间：2018-09-12 19:21

【摘要】：目的：本课题的研究旨在通过观察输卵阻塞性不孕症患者经腹腔镜术后中医药治疗与单纯行腹腔镜术后的临床疗效,分析手术两组病例治疗前后血清肿瘤坏死因子(TNF-α)水平、术后输卵管再通率、妊娠率以及中医症状、局部体征的改善情况,以期为输卵管积水不孕患者提供切实可行的治疗手段。方法：将60例符合中西医诊断标准的输卵管积水不孕患者,随机分为治疗组30例(腹腔镜手术配合中药治疗)和对照组30例(单纯手术治疗)。治疗组于术后连续口服中药3个月,并随访6月。治疗前后对上诉两组分别进行安全性观察以及疗效性检测。观察两组治疗前后妊娠率、中医证候、局部体征表现及肿瘤坏死因子α等理化指标变化情况,比较两组治疗后组间的差异。结果：1.采用腹腔镜手术联合中药口服治疗较单纯运用腹腔镜手术治疗对患者术后9个月内的受孕率具有显著差异(P0.05)；2.即使未能成功受孕,中药联合腹腔镜治疗相比于单纯腹腔镜治疗可获得更高的输卵管通畅率(P0.01)；3.治疗后中医证候疗效进行比较,中药联合腹腔镜组总有效率达到90.0%,显著优于单纯腹腔镜治疗组的80%有效率(P0.05)。4.两种治疗方法均能够使输卵管阻塞性不孕症患者的局部体征得到明显改善,中药联合腹腔镜治疗组与单纯腹腔镜治疗组总有效率分别为93.33%、76.67%,两组间疗效相比,中药联合治疗组的优势更为显著(P0.05)。5.中药联合腹腔镜治疗与单纯腹腔镜治疗均可显著降低治疗前血清TNF-a水平(P0.01),但两者相比,中药联合组对TNF-α的降调影响更为显著(P0.01)。6.安全性分析：血常规、尿常规、粪便常规、肝肾功能、常规心电图检测在治疗组30例患者用药前后的均无异常,提示该疗法无明显不良反应及毒副作用。结论：1.腹腔镜手术能够有效通过松解盆腔的局部粘连、恢复输卵管卵巢正常的解剖结构,达到纠正输卵管阻塞的治疗目的；2.中药治疗对该病具有显著效果,体现在其所具有的综合疗效、证候疗效、局部体征疗效等多个方面,其作用机制可能与药物调节患者输卵管局部炎性因子,如TNF-α的水平,进而减轻炎性反应,减少水肿及纤维素样渗出,降低或延缓输卵管粘连可能,并通过改善盆腔局部血流、抑菌杀菌、镇痛解痉等有关功效,共同达到治疗目的；3.腹腔镜手术后结合中药可以显著提高对临床症状、体征的改善程度,减轻患者不适,提供更好的受孕环境。
[Abstract]:Objective: the purpose of this study was to observe the clinical effects of traditional Chinese medicine (TCM) and laparoscopic surgery (Laparoscopic only) in patients with obstructive infertility after oocyte transfusion, and to analyze the serum levels of tumor necrosis factor (TNF- 伪) before and after treatment in two groups of patients. The rate of fallopian tube recanalization, pregnancy rate and the improvement of symptoms and local signs of traditional Chinese medicine were discussed in order to provide practical treatment for infertile patients with hydrosalpinx. Methods: sixty infertile patients with hydrosalpinx were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group was treated with oral Chinese medicine for 3 months and followed up for 6 months. The safety and efficacy of the two groups were observed before and after treatment. The changes of pregnancy rate, TCM syndromes, local physical signs and tumor necrosis factor 伪 (TNF- 伪) were observed before and after treatment, and the differences between the two groups were compared. The result is 1: 1. Laparoscopic surgery combined with oral Chinese medicine treatment compared with the use of laparoscopic surgery alone in 9 months after the pregnancy rate of patients with significant differences (P0.05). 2. Even if it failed to conceive successfully, the rate of tubal patency (P0.01) in combination with laparoscopy was higher than that in laparoscopy alone (P0.01). After treatment, the total effective rate of traditional Chinese medicine combined with laparoscopy group reached 90.0, significantly better than the 80% effective rate of simple laparoscopic treatment group (P0.05). 4. The local physical signs of patients with oviduct obstructive infertility were significantly improved by both methods. The total effective rates of the Chinese medicine combined with laparoscopy group and the simple laparoscopic treatment group were 93.33 and 76.67, respectively. The curative effect was compared between the two groups. The advantages of traditional Chinese medicine combined treatment group were more significant (P0.05). Compared with traditional Chinese medicine combined with laparoscopic therapy and laparoscopic therapy alone, serum TNF-a level was significantly decreased (P0.01), but the effect of TCM-combined group on TNF- 伪 was more significant (P0.01) .6. Safety analysis: blood routine, urine routine, stool routine, liver and kidney function, routine electrocardiogram were not abnormal in 30 cases of treatment group before and after treatment, indicating that the treatment has no obvious adverse reactions and side effects. Conclusion 1. Laparoscopic surgery can effectively release local adhesions of the pelvic cavity and restore the normal anatomical structure of the oviduct and ovary, and achieve the purpose of correcting the obstruction of the fallopian tube. Traditional Chinese medicine treatment has remarkable effect on the disease, which is reflected in its comprehensive curative effect, syndromes curative effect, local sign curative effect and so on. The mechanism of its action may be related to the level of local inflammatory factors, such as TNF- 伪. It is possible to reduce inflammatory reaction, reduce edema and fibrous exudation, decrease or delay fallopian tube adhesion, and through improving pelvic local blood flow, bacteriostasis, analgesia and spasmolysis, etc. Laparoscopy combined with traditional Chinese medicine can significantly improve the clinical symptoms and signs, reduce the discomfort of patients, and provide a better pregnant environment.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

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