红藤合剂保留灌肠联合选择性输卵管造影再通治疗血瘀输卵管阻塞性不孕症随机平行对照研究

Treatment of Oviduct Obstructive Infertility by Sargent Gloryvine Mixture Retention Enema combined with Selective Salpingography and Recanalization Randomized Parallel Control Study

[目的]观察红藤合剂保留灌肠联合选择性输卵管造影-再通治疗血瘀输卵管阻塞性不孕症疗效。[方法]使用随机平行对照方法,将61例住院患者按随机数字表法简单随机分为两组。对照组31例月经干净后3~7d,输卵管梗阻-选择性输卵管造影+再通术:宫腔内引入再通同轴导管,以3F导管选择一侧输卵管,成功后造影,伞端通而欠畅,奥硝唑100m L,左克0.2g,地塞米松5mg,胎盘多肽4m L,充分混匀成治疗液,取50m L,加压推注,约20m L后阻力不明显,造影,一侧输卵管通畅,退管,同法处理对侧输卵管;治疗后1例再通失败,3例重度通而不畅,2例轻度通而不畅,重度及轻度通而不畅腹腔镜手术:全麻+连续硬膜外麻醉,腹腔镜直视下自宫颈管注入亚甲蓝液体,明确输卵管通畅程度;分离盆腔黏连,充分暴露手术视野;壶腹部或输卵管伞端闭锁,造口成形,镜下输卵管美蓝通液术;然后术泰舒及几丁糖等抗黏连药物注入盆腔,术后抗生素预防感染一周,待下个月经周期月经干净3~7d输卵管通液术(生理盐水20m L+左氧氟沙星0.2g+胎盘多肽4m L)。治疗组30例,红藤合剂保留灌肠(红藤30g,乳香炙、没药炙各10g,夏枯草20g,毛冬青、皂刺炙各30g,半枝莲20g,白芷、桔梗各10g),水煎150m L;选择性输卵管造影+再通术后阴道无异常出血或下次月经干净后,排空膀胱和直肠,取左侧卧位,双腿屈曲,臀部加枕头抬高至少10cm,药液加温至36~37℃,注入距床面高度约50cm灌肠袋,灌肠器前端涂液体石蜡,排净灌肠器前段气体,缓慢插入肛门内约15~20cm,缓慢输入药液后将灌肠器从肛门轻柔退出,保留≥2h,1次/晚,经期停用;西医治疗同对照组。连续治疗1个月经周期为1疗程。观测临床症状、受孕、输卵管通畅、不良反应。连续治疗3疗程(3个月经周期),判定疗效。[结果]输卵管再通率对照组71%低于治疗组93.3%(P<0.05);妊娠率对照组51.6%低于治疗组86.7%(P<0.05)。[结论]红藤合剂保留灌肠联合选择性输卵管造影、再通治疗血瘀输卵管阻塞性不孕症,疗效满意,无严重不良反应,值得推广。

[Objective] Observe the effect of treatment of oviduct obstructive infertility by Sargent gloryvine mixture retention enema combined with selective salpingography and recanalization. [Methods] Using randomized parallel control method, 61 patients are randomly divided into two groups according to the digital table method. The control group of 31 cases improves the routine examination after 3 to 7 days of menstruation. Fallopian tube obstruction is given selective salpingography and recanalization： patients are in the supine position, with perineum disinfected, covering towels, introducing coaxial catheter of recanalization into uterine cavity, selecting one side fallopian tube with 3F catheter, and make salpingography, fimbria is partially obstructed. Then ornidazole 100mL, levofloxacin hydroehloride injection 0.2g, dexamethasone 5mg, placental peptide 4mL are fully mixed into treatment solution. Take 50mL of treatment solution, pressurized injection, the resistance is not obvious after about 20mL, with salpingography, one side of the oviduct is unobstructed, then take off the catheter, treatment of contralateral fallopian tube with the same method. After treatment, 1 case failed recanalization, 3 cases were partially severe obstructed, 2 cases werepartially mild severe obstructed, severe and mild situations were access to laparoscopic surgery： general anesthesia＋continuous epidural anesthesia into the abdomen, the laparoscopic direct injection of methylene blue liquid from the cervix, make clear the fallopian tube patency; according to intraoperativc findings given targeted therapy, such as the existence of pelvic adhesions, first separate the adhesions in order to fully expose the surgical field of vision; if the ampullar region or fimbriated extremity of fallopian have atresia, then give it tracheostomy, thereafter give microscopic fallopian tube methyleneblue smoothness test to see whether there is further improvement after surgery; finally, anti-adhesion drugs such as Shutaishn and chitosan are injected into the pelvic cavity to prevent recurrence of adhesions. After antibiotic treatment for one week, to prevent infection, until the end of next menstrual cycle, after 3 to 7 days, give hydrotubation （saline 20mL＋levofloxacin 0.2g＋placental polypeptide 4mL）. 30 cases of the treatment group have no vaginal bleeding after treatment or after the end of next menstruation to give Sargent gloryvine mixture retention enema （Sargent gloryvine 30g, frankincense 10g, myrrh 10g, Prunella 20g, Ilex pubescens 30g, spina gleditsiae 30g, Sculellaria barbata 20g, Angelica dahurica 10g, Platycodon grandiflorum 10g）, according to clinical symptoms to add and subtract, decoct with water of 150mL. Before treatment, inform the patient emptying the bladder and rectum, the potion heated to 36-37 ℃, to avoid burns. In the disposable enema bag with a bed surface height of about 50cm, the patients are allowed to urinate and defecate before enema to facilitate the retention of liquid medicine for a long time. Take the left lateral position, legs flexion, and pillows under buttocks raise at least 10cm. The front end of the enema device is coated with liquid paraffin, which is inserted into the anus for about 15 to 20 cm after discharging the gas in the front part of the enema device, slowly inject the liquid, after the injection, gently withdraw enema device from the anus, lasting more than 2 hours, 1 time per night, stop using in the menstruation; western medicine treatment is the same as control group. Continuous treatment of one menstrual cycle is one course. Observe clinical symptoms, pregnancy, tubal patency and adverse reactions. Continuous treatment of 3 courses （3 menstrual cycles）, determine efficacy. [Results] The control group fallopian tube recanalization rate is 71%, the treatment group fallopian tube recanalization rate is 93.3%, the control group is significantly lower than the treatment group, the difference is statistically significant （P〈0.05）; after treatment, the control group pregnancy rate is 51.6%, the treatment group pregnancy rate is 86.7%, the control group is significantly lower than the treatment group, the difference is statistically significant （P〈0.05）. [Conclusion] The effect of treatment of oviduct obstructive infertility by Sargent gloryvine mixture retention enema combined with selective salpingography and recanalization is satisfied, without serious adverse reactions, which is worthy of promotion.