子宫腺肌病腹腔镜病灶切除术后应用促性腺激素释放激素激动剂联合中药内异消临床研究

Clinical study of integrated therapy for adenomyosis with laparoscopic excision of lesions and GnRH-a and traditional Chinese remedy-Neiyixiao

目的探讨腹腔镜病灶切除术后应用促性腺激素释放激素激动剂(GnRH-a)联合中药内异消治疗子宫腺肌病并保留生育功能的可行性。方法收集2014年10月至2016年10月在上海中医药大学附属曙光医院妇科住院治疗的生育期子宫腺肌病患者32例,应用悬吊式腹腔镜联合改良环形电切术进行子宫腺肌病病灶切除术,术后均给予注射Gn RH-a治疗6个月及中药内异消口服12个月。术后随访18个月,比较治疗前后月经量、痛经、子宫体积、血清CA125变化情况和中医证候积分以及复发率和妊娠率。结果与治疗前比较,Gn RH-a治疗后首次月经来潮时及术后12、18个月的月经量、痛经和中医证候积分差异有统计学意义(P<0.05),子宫体积和血清CA125均显著下降(P<0.05)。手术后18个月复发率3.13%,妊娠率6.25%。内异消服用12个月后,患者肝肾功能均正常。结论子宫腺肌病腹腔镜病灶切除术后应用GnRH-a联合中药内异消治疗可显著改善月经过多、痛经等症状,复发率降低,部分患者仍可妊娠分娩。内异消长期服用无明显影响肝肾功能等副反应。

Objective To study the therapeutic effects and uterus-reserved feasibility of an integrated Western and Chinese Traditional remedy-combined treatment of Gn RH-a and Neiyixiao prescription for severe adenomyosis after laparoscopic lesion excision.Methods From Oct. of 2014 to Oct. of 2016,a total of 32 reprouctive-age patients with adenomyosis severe received in our hospital were observed. All patients underwent laparoscopic excision of lesions and were given integrated treatment afterwards. The postoperative treatment included Gn RH-a injection（ for 6 months）and Chinese Traditional remedy —Neiyixiao（for 12 months）.The menstrual bleeding quantity,degree of dysmenorrhea,uterine size,serum CA125 level,and traditional Chinese symptom complex（TCSC）score were observed respectively before surgery and after giving postoperative treatment. After the 18 months postoperative follow-up,the recurrence rate and pregnancy rate were recorded.Results The menstrual bleeding,dysmenorrhea and TCSC score were significantly improved（P〈0.05）after treatment,and uterine size and serum CA125 were obviously descended（P〈0.05）respectively at the first menstrual onset after Gn RH-a injection,the 12 th and the 18 th month postoperatively. The recurrence rate and the pregnancy rate were 3.13% and 6.25% respectively in 18-month follow up.Conclusion The results suggest that integrated treatment for adenomyosis using laparoscopy,postoperative Gn RH-a and oral Chinese traditional remedy — Neiyixiao was clinically effective in relieving the severe menstrual bleeding and dysmenorrhea and in controlling the recurrence. The reservation and reduction of uterine may provide benefit to save the fertility to some extent.