复方大血藤灌肠剂联合GnRH-a治疗腹腔镜术后子宫内膜异位症的临床研究

Compound Daxueteng Enemas Combined with GnRH-a on Endometriosis after Laparoscopic Surgery: A Clinical Research

目的观察复方大血藤灌肠剂与促性腺激素释放激素激动剂(GnRH-a)各自单用及联合应用对腹腔镜保守手术后子宫内膜异位症(EMs)患者的临床疗效。方法选取2015年1月—2017年3月经浙江省中医院腹腔镜确诊并行保守手术的瘀热互结型EMs患者65例,随机分为单纯复方大血藤组18例(术后予复方大血藤灌肠剂保留灌肠)、单纯GnRH-a治疗组24例(术后予GnRH-a治疗)、联合治疗组23例(术后复方大血藤灌肠剂保留灌肠及GnRH-a联合治疗),共治疗4个月。记录治疗前、后主观症状评分;治疗结束后随访1年,比较和分析各组患者临床疗效、妊娠率;检测治疗前、治疗第8、16周及治疗后性激素水平[雌二醇(E_2),促黄体生成素(LH),促卵泡刺激素(FSH)]水平。结果单纯复方大血藤组、单纯GnRH-a治疗组及联合治疗组总有效率分别为55.56%(10/18)、54.17%(13/24)、91.30%(21/23),复发率为33.33%(6/18)、33.33%(8/24)、4.35%(1/23),妊娠率为38.89%(7/18)、41.67%(10/24)、78.26%(18/23)。3组总有效率、复发率、妊娠率比较,差异有统计学意义(χ~2=7.034,9.083,8.569,P=0.03,0.011,0.014);与联合治疗组比较,单纯复方大血藤组及单纯GnRH-a治疗组复发率升高(χ~2=5.992,6.373,P=0.014,0.012),总有效率降低(χ~2=6.998,8.096,P=0.008,0.004),且妊娠率降低(χ~2=6.578,6.531,P=0.010,0.001)。与本组治疗前比较,3组治疗后患者非月经期、月经期主观症状评分均降低(P<0.05),且联合治疗组治疗后非月经期、月经期主观症状评分较其他两组降低(P<0.05)。治疗第8、16周单纯GnRH-a治疗组、联合治疗组E_2、LH和FSH水平均比治疗前降低(P<0.05);与联合治疗组比较,单纯复方大血藤组治疗第8、16周E_2、LH和FSH水平升高(P<0.05)。结论单用复方大血藤灌肠剂或GnRH-a,其临床疗效无明显差异;两者联合使用能够明显改善腹腔镜保守手术后EMs患者的临床疗效、妊娠率,降低其复发率。

Objective To evaluate the effect of Compound Daxueteng Enemas combined with gonadotropin-releasing hormone agonists(GnRH-a)on endometriosis(EMs) after laparoscopic surgery. Methods From January 2015 to March 2017, 65 EMs cases of blood and heat accumulation syndrome that underwent laparoscopic conservative surgery in Zhejiang Provincial Hospital of TCM were randomly assigned to group of Compound Daxueteng Enemas with 18 cases(given retention enema of Compound Daxueteng Enemas after surgery),group of GnRH-a with 24 cases(given hypodermic injection of GnRH-a after surgery)and group of combined treatment with 23 cases(given retention enema of Compound Daxueteng Enemas combined with hypodermic injection of GnRH-a after surgery). The treatment course was 4 months. The scores of subjective symptoms before and after treatment were recorded. And the observation course was 1 year.The efficacy,pregnancy rate and female hormone[estradiol(E2), luteinizing hormone(LH), follicle stimulating hormone(FSH)] before treatment, at 8th week, at 16th week and after treatment were compared among the three groups. Results After treatment, the three groups′ total effective rates were 55.56%(10/18), 54.17%(13/24), 91.30%(21/23). The recurrence rates were 33.33%(6/18), 33.33%(8/24), 4.35%(1/23).The pregnancy rates were 38.89%(7/18), 41.67%(10/24),78.26%(18/23). The differences of the total effective rates, recurrence rates and pregnancy rates were statistically significant in the three groups(χ^2=7.034, 9.083, 8.569;P=0.03, 0.011, 0.014). Compared with group of combined treatment, the other two groups had higher recurrence rates(χ^2=5.992,6.373, P=0.014,0.012), lower total effective rates(χ^2=6.998,8.096, P=0.008,0.004) and lower pregnancy rates(χ^2=6.578,6.531, P=0.010,0.001). Compared with pre-therapy, the subjective symptoms scores(menstrual and non-menstrual periods) in each group were brought down after treatment(P<0.05), and the group of combined treatment had the best decrease(P<0.05). The level of E2, FSH and LH at the 8th and 16th week in group of GnRH-a and group of combined treatment were brought down after treatment(P<0.05), while those in group of Compound Daxueteng Enemas were higher compared with group of combined treatment(P<0.05).Conclusions Exclusive therapy with Compound Daxueteng Enemas or GnRH-a had no significant difference on EMs patients after surgery. The combination of Compound Daxueteng Enemas with GnRH-a had a better efficacy, a lower recurrence rate and a higher pregnancy rate.