化瘀消癥汤保留灌肠预防血瘀型卵巢内膜样囊肿患者腹腔镜保留生育功能术后复发的疗效观察

Efficacy of retention enema with Huayuxiaozheng decoction in preventing recurrence of ovarian endometrial cyst after fertility preserving surgery

目的探讨血瘀型卵巢内膜样囊肿患者腹腔镜保留生育功能手术后使用化瘀消癥汤保留灌肠治疗预防复发、改善中医证候及炎症因子水平的效果。方法选取2018年7月至2019年6月间上海市宝山区中西医结合医院收治的血瘀型卵巢内膜样囊肿腹腔镜保留生育功能手术治疗的79例患者,根据治疗方法不同分为治疗组和对照组。术后予中药化瘀消癥汤保留灌肠治疗的40例患者纳入治疗组,术后予促性腺激素释放激素激动剂(GnRH-a)常规治疗的39例患者纳入对照组。观察两组患者的临床复发、中医证候评分、视觉模拟评分(VAS)、不良反应发生率、外周血糖类抗原(CA125)、性激素水平及炎症因子水平等。结果术后6个月时,治疗组复发1例,复发率2.5%,对照组复发1例,复发率2.6%,两组比较,差异无统计学意义(P>0.05)。术后3个月和6个月时,两组患者外周血CA125和VAS评分比较,差异无统计学意义(P>0.05),且两组患者上述指标与术前比较,差异均有统计学意义(均P<0.05)。术后3个月、6个月,治疗组未发生不良反应,对照组潮热出汗和关节疼痛分别为52.6%和23.7%,治疗组低于对照组,差异均有统计学意义(均P<0.05)。两组患者中医证候评分术后均有改善,术后3个月、6个月时治疗组中医证候评分优于对照组,差异均有统计学意义(均P<0.05)。与术前比较,术后3个月时,两组患者的雌二醇(E2)均下降,且治疗组的E2高于对照组;治疗组的血清促卵泡生成素(FSH)和促黄体生成素(LH)均升高,对照组血清FSH和LH均较术前降低;治疗组的FSH和LH均高于对照组,差异均有统计学意义(均P<0.05)。术后6个月,两组患者的E2、FSH和LH比较,差异无统计学意义(P>0.05)。术后3个月时,治疗组的白细胞介素-2(IL-2)高于对照组,IL-4、IL-6均低于对照组,差异均有统计学意义(均P<0.05)。结论与GnRH-a治疗相比,中药化瘀消癥汤保留灌肠治疗血瘀型卵巢内膜样囊肿也可有效预防术后复发,降低疼痛评分与外周血CA125水平,并改善患者中医证候评分及炎症因子水平,且无明显不良反应,可临床应用推广。

Objective To study the clinical efficacy of retention enema with in Huayuxiaozheng decoction in preventing recurrence of ovarian endometrial cyst and improving Traditional Chinese Medicine(TCM)symptoms and inflammatory factor levels after fertility preserving surgery.Methods Seventy-nine patients undergoing laparoscopic fertility-preserving surgery for endometrioid cysts of ovary were selected at Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine from July 2018 to June 2019.They were classified into a treatment group and a control group based on the therapy they received.Forty patients receiving retention enema with in Huayuxiaozheng decoction after the operation were included in the treatment group and 39 patients receiving conventional treatment with gonadotrophin releasing hormone analogue(GnRHa)after the operation were included in the control group.Clinic recurrence,TCM symptoms,visual analogue scale(VAS)score,incidence of adverse reactions and carbohydrate antigen 125(CA125),hormone and inflammatory factor levels were compared between the two groups.Results Recurrence occurred in 1 patient in the treatment group(2.5%)and 1 patient in the control group(2.6%)at 3 months after operation and there was no significant difference between the two groups(P>0.05).There was no significant difference in CA125 in peripheral blood and VAS score at 3 months and 6 months between the two groups(P>0.05).There were significant differences in the above indices compared with those before the surgery(all P<0.05).No adverse reaction occurred in the treatment group at 3 months and 6 months after operation(P>0.05).The incidence of hot flashes and sweating was 52.6%and 23.7%,respectively in the control group(all P<0.05).Scores of TCM symptoms were improved in both groups(all P<0.05).Scores of TCM symptoms at 3 months and 6 months after the surgery were better in the treatment group than in the control group(all P<0.05).Compared with before the surgery,estradiol(E2)decreased in both groups at 3 months after the surgery with E2 level higher in the treatment group than in the control group(all P<0.05).At3 months,follicle-stimulating hormone(FSH)levels and luteinizing hormone(LH)levels increased in the treatment group and decreased in the control group.FSH and LH levels were higher in the treatment group than in the control group(all P<0.05).There was no significant difference in E2,FSH and LH levels between the two groups at 6 months after the surgery(P>0.05).At interleukin(IL)-2,was higher in the treatment group than in the control group and IL-4 and IL-6 were lower in the treatment group than in the control group(all P<0.05).Conclusion Compared with treatment with GnRH-a,retention enema with Traditional Chinese Medicine Huayuxiaozheng decoction for endometrioid cysts of ovary can also effectively prevent postoperative recurrence,reduce VAS pain score and CA125 level in peripheral blood,relieve TCM syndrome and improve inflammation factor levels with no obvious side effects.It can be effectively clinically promoted.