针药结合预防子宫内膜异位症腹腔镜手术后复发疗效观察

Efficacy observation on the combination of acupuncture and Chinese medication in prevention of the recurrence of endometriosis after laparoscopic surgery

目的:评价针灸结合中药加味没竭片预防子宫内膜异位症患者腹腔镜手术后复发的疗效及安全性。方法:将经腹腔镜手术治疗后子宫内膜异位症患者120例随机分为针灸组、西药组、中药组、针药组,每组30例。针灸组采用针灸治疗,针刺取血海、三阴交、关元为主穴,并于关元穴行隔姜灸,每日1次,每周2次;西药组口服孕三烯酮2.5mg,每日1次,每周2次;中药组口服院内制剂加味没竭片;针药组采用针灸治疗并口服加味没竭片,方法同针灸组与中药组,共治疗3个月。分别于治疗前、治疗后、治疗后3个月和治疗后6个月比较各组患者疗效性指标[子宫内膜异位症生存质量量表(endometriosis health profile-5,EHP-5)评分、腹部/阴部超声检查、血清CA125检测]及安全性指标(血清谷丙转氨酶检测)。结果:治疗后3个月及治疗后6个月,针药组EHP-5评分阳性率0%(0/30)和针灸组0%(0/30)均显著低于西药组13.3%(4/30,均P<0.05),但与中药组无差异。治疗后6个月随访,针药组超声检查无疑似复发病例,其复发率0%(0/30)显著低于西药组的13.3%(4/30,P<0.05);针药组血清CA125检测无异常病例,其异常率0%(0/30)亦低于西药组的16.7%(5/30,P<0.05)。疗程结束时及疗程结束后3个月随访,血清谷丙转氨酶异常率西药组分别为20.0%(6/30)、13.3%(4/30),均高于其他各组(P<0.05);疗程结束后6个月随访,西药组血清谷丙转氨酶虽有3例异常,但与其他各组比较差异无统计学意义(P>0.05)。结论:针灸结合中药加味没竭片可有效预防子宫内膜异位症腹腔镜手术后复发,提高患者生活质量,且较西药孕三烯酮肝损害小,具有肯定的疗效和安全性。

Objective To evaluate the efficacy and safety of acupuncture-moxibustion combined with modified Mojie tablet （加味没竭片） in the prevention of the recurrence of endometriosis （EMS） after laparoscopic surgery. Methods After taparoscopic surgery, 120 cases of EMS were randomized into an acupuncture-moxibustion group, a western medication group, a Chinese medication group and a combined therapy of acupuncture-moxibustion and Chinese medication group （combined therapy group）, 30 cases in each one. In the acupuncture-moxibustion group, acupuncture was applied at Xuehai （SP 10）, Sanyinjiao （SP 6） and Guanyuan （CV 4）; the isolated moxibustion with ginger was used at Guanyuan （CV 4）, once a day, twice a week. In the western medication group, gestrinone was prescribed for oral administration, 2.5 rag, once a day, twice a week. In the Chinese medication group, the self-prepared Mojie tablet were prescribed for oral administration. In the combined therapy group, acupuncture, moxibustion and modified Mojie tablet for oral administration were used in combination. The therapeutic methods were same as the acupuncture-moxibustion group and the Chinese medication group. Totally, the treatment of 3 months was required. Separately, before treatment, after treatment, in 3 months after treatment and in 6 months after treatment, EHP-5 score （endometriosis health profile-5）, the abdominal/vaginal ultrasound exami-nation, serum CA125 detection and safety index （ALT detection） were compared in patients among 4 groups. Results In 3 and 6 months after treatment, the positive rates of EHP-5 score were 0% （0/30） in the combined therapy group and 0% （0/30） in the acupuncture-moxibuston group, which were all lower significantly than 13.3% （4/30） in the western medication group （both P〈0.05）. In follow-up stage of 6 months after treatment, there was no recurrence case in abdominal lviginal ultrasound examination in the combined therapy group, which was lower than 13.3% （4/30） in the western medication group （P〈O. 05） ; the serum CA125 detection in the combined therapy group did not find any abnormal ease, which was lower than 16.7% （5/30） in the western medica- tion group （P〈0.05）. At the end of treatment session and in the follow-up stage of 3 months after treatment, the abnormal rate of ALT were 20.0% （6/30） and 13.3%（4/30） in the western medication group, which were high- er than those in any of the rest groups （P〈0.05）. In the follow-up stage of 6 months after treatment, there were 3 abnormal cases of ALT in the western medication group, but which was not different significantly as compared with the rest groups （P〈0.05）. Conclusion Acupuncture and moxibustion combined with modified Mojie tablet effectively prevent from the recurrence of EMS after laparoscopic surgery and improve the life quality of the patients. This combined therapy brings less damage on the liver as compared with the western medication of gestrinone and indicates its definite efficacy and safety.