腹腔镜手术联合祛瘀解毒方治疗子宫内膜异位症不孕的临床研究

Clinical Study on Treatment of Endometriosis-related Infertility Patients by Laparoscopic Surgery in Combination of Quyu Jiedu Recipe

目的探讨腹腔镜手术联合祛瘀解毒方治疗血瘀蕴毒型子宫内膜异位症(endometriosis,EMs)不孕患者的临床疗效。方法将130例经腹腔镜手术确诊并治疗的血瘀蕴毒型EMs不孕患者随机分成试验组(75例)与对照组(55例)。两组患者术后均行常规助孕治疗,试验组患者于腹腔镜术后加用祛瘀解毒方颗粒,共治疗12个月。比较两组术后1年内妊娠率,术后用药前及用药后3个月中医证候积分改善情况、血清抗子宫内膜抗体(endometrium antibody,EMAb)及癌抗原125(cancer antigen125,CA125)水平。结果试验组术后1年内妊娠率(61·33%,46/75)高于对照组(45·45%,25/55),差异有统计学意义(P<0·05)。试验组用药前及用药后3个月中医证候积分分别为(16·07±6·77)分和(7·25±3·27)分,对照组分别为(15·92±7·51)分和(12·73±6·12)分,两组用药后中医证候积分均降低,且试验组用药前后积分差值(分,9·12±6·16)大于对照组(3·48±2·06),差异均有统计学意义(P<0·05)。用药后3个月,试验组血清EMAb阳性转阴率(44·44%)明显高于对照组(15·62%),差异有统计学意义(P<0·05)。试验组用药前及用药后3个月血清CA125分别为(31·88±15·78)U/mL及(18·82±10·08)U/mL,对照组分别为(30·63±19·28)U/mL及(18·05±11·20)U/mL,两组用药后血清CA125水平均降低(P<0·05),两组间比较差异无统计学意义(P>0·05)。结论腹腔镜手术联合祛瘀解毒方可有效改善血瘀蕴毒型EMs不孕患者临床症状,促进血清EMAb转阴,降低血清CA125水平,提高临床妊娠率,是治疗血瘀蕴毒型EMs不孕的有效方药。

Objective To study the clinical efficacy of the laparoscopic surgery in combination of Quyu Jiedu Recipe（QYJDR） on endometriosis（EMs）-related infertility patients.Methods 130 EMs-related infertility patients of blood stasis and toxin accumulation syndrome diagnosed and treated by laparoscopic surgery were randomly assigned to two groups,i.e.,the test group（75 cases） and the control group（55 cases）.All patients received routine progesterone treatment after laparoscopic surgery.QYJDR was given to patients in the test group after laparoscopic surgery,lasting for twelve months.The pregnancy rate within one year after laparoscopic surgery were compared between the two groups.The Chinese medicine syndrome integrals,serum endometrium antibody（EMAb） and cancer antigen 125（CA125） levels were compared between before drug therapy and three months after drug therapy.Results The pregnancy rate within one year after laparoscopic surgery was higher in the test group than in the control group [61.33%（46/75） vs 45.45%（25/55）],showing significant difference（P0.05）.The Chinese medicine syndrome integral was（16.07±6.77） score and（7.25±3.27） score before and 3 months after drug therapy in the test group,while it was（15.92±7.51） score and（12.73±6.12） score in the control group.The Chinese medicine syndrome integral after drug therapy was lower than that before drug therapy in the same group.Besides,the integral difference between before and after drug therapy was higher in the test group than in the control group [（9.12±6.16） score vs（3.48±2.06） score）],showing statistical difference（P0.05）.After three-month drug therapy,the serum EMAb negative conversion rate was obviously higher in the test group than in the control group（44.44% vs 15.62%）,showing statistical difference（P0.05）.The serum CA125 level was（31.88±15.78） U/mL before drug therapy and（18.82±10.08） U/mL three months after drug therapy in the test group,while it was（30.63±19.28） U/mL and（18.05±11.20） U/mL respectively in the control group.It was lowered after drug therapy in the two groups with statistical difference（P0.05）.There was no statistical difference between the two groups after drug therapy（P0.05）.Conclusions The laparoscopic surgery in combination of QYJDR could effectively improve clinical symptoms of EMs patients of blood stasis and toxin accumulation syndrome,promote negative conversion of EMAb,lower serum CA125 levels,and elevate the clinical pregnancy rate.QYJDR is an effective formula in treatment of EMs-related infertility.