疏肝散结汤联合米非司酮在腹腔镜术后子宫肌瘤患者中的应用

Application of Shugan Sanjie Decoction Combined with Mifepristone in the Treatment of Patients with Uterine Fibroids after Laparoscopic Surgery

目的:观察疏肝散结汤联合米非司酮用于子宫肌瘤患者腹腔镜术后的价值,主要观察药物对患者术后复发及性激素水平的影响,为该类疾病术后合理用药提供参考。方法:选择2017年1月~2019年1月本院收治的70例血瘀证子宫肌瘤患者作为研究对象,采用单盲法,并根据随机数字表法将患者分为对照组和观察组,各35例,治疗期间无患者脱落。全部患者均接受腹腔镜下子宫肌瘤剥除术治疗,在此基础上,对照组于术后给予米非司酮治疗,观察组于术后给予疏肝散结汤联合米非司酮治疗。分别于治疗前、治疗12周后,检测并比较两组性激素[雌二醇(E_(2))、黄体生成素(LH)、促卵泡激素(FSH)]指标水平;随访12个月,记录并比较两组术后0~3个月、4~7个月、8~12个月的复发率及12个月内总复发率;于治疗前、治疗12周后,评估并比较两组中医证候积分,记录两组治疗期间不良事件发生情况。结果:治疗12周后,两组患者E_(2)水平均较治疗前降低,且观察组低于对照组;两组LH、FSH水平均较治疗前升高,且观察组高于对照组,有统计学差异(P <0.05);两组术后随访各时段复发率比较无统计学差异(P> 0.05);观察组术后12个月内总复发率低于对照组,有统计学差异(P <0.05);治疗12周后,两组患者中医证候各项主证积分及总积分均较治疗前降低,且观察组低于对照组,有统计学差异(P <0.05);两组治疗期间均无不良事件发生。结论:疏肝散结汤联合米非司酮可预防子宫肌瘤患者术后复发、促进患者症状恢复,并可改善患者性激素水平,且不会增加患者治疗期间不良事件发生率,安全性高。

Objective:To observe the value of Shugan Sanjie decoction combined with mifepristone in patients with uterine fibroids after laparoscopic surgery,to observe the effect of the drugs on postoperative recurrence and sex hormone levels of patients,and to provide the references for the rational drug use for such diseases.Methods:70 patients with uterine fibroids with syndrome of blood stasis admitted to the hospital from January 2017 to January 2019 were selected.The single blind method was used and the patients were divided into control group and observation group,with 35 cases in each group,according to the random number table method.There were no patients dropped out during treatment.All patients underwent laparoscopic hysteromyoma.On this basis control group was given mifepristone after surgery,and observation group with Shugan Sanjie decoction combined with mifepristone after surgery.Before treatment and 12 weeks after treatment,the levels of sex hormones[estradiol(E 2),luteinizing hormone(LH)and follicle stimulating hormone(FSH)]in two groups were detected and compared.Followed up for 12 months,the recurrence rate of two groups during 0~3 months,4~7 months,8~12 months and the total recurrence rate within 12 months were recorded and compared.Before treatment and 12 weeks after treatment,the TCM syndrome scores of two groups were evaluated and compared.The adverse events during the treatment period of two groups were recorded.Results:The levels of E 2 in both groups after 12 months treatment were lower than those before treatment,with more reduction found in observation group than control group;The levels of LH and FSH in both groups were higher than those before treatment,with more increase found in observation group than control group,with statistically significant difference(P<0.05);There was no statistically significant difference in the recurrence rate in each period of postoperative follow-up between two groups(P>0.05);The total recurrence rate in observation group within 12 months after surgery was lower than that in control group,with statistically significant difference(P<0.05);After 12 weeks of treatment,the main TCM syndrome scores and total scores of two groups were lower than those before treatment,and observation group was lower than control group,with statistically significant difference(P<0.05);There were no adverse events during the treatment period in two groups.Conclusion:Shugan Sanjie decoction combined with mifepristone in patients with uterine fibroids can prevent postoperative recurrence,promote recovery of symptoms,improve sex hormone levels,without increasing adverse events during treatment,which has high safety.