归肾丸加减联合人工周期治疗宫腔粘连术后再粘连的临床疗效观察

Clinical Efficacy Observation of Modified Guishen Pills Combined with Artificial Periodic Therapy for the Treatment of Post-operative Adhesion in Patients with Intrauterine Adhesion

【目的】观察归肾丸加减联合人工周期治疗宫腔粘连术后再粘连的临床疗效。【方法】将76例肾虚血瘀型中、重度宫腔粘连患者随机分为观察组和对照组,每组各38例。2组患者均给予宫腔镜下宫腔粘连分离术(TCRA)治疗,对照组患者在TCRA术后给予单纯人工周期治疗,观察组在对照组的基础上给予补肾活血中药(方用归肾丸加减)治疗,疗程为3个月经周期。观察2组患者治疗前后的子宫内膜厚度、宫腔粘连评分和中医证候积分的变化情况,评价2组患者的临床疗效。【结果】(1)治疗3个月经周期后,观察组的总有效率为89.47%(34/38),对照组为78.95%(30/38),组间比较,观察组的疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的中医证候积分均较治疗前明显降低(P<0.05),且观察组对中医证候积分的降低作用明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的子宫内膜厚度均较治疗前明显增厚,宫腔粘连评分均较治疗前明显降低(P<0.05),且观察组对子宫内膜厚度的增厚作用及对宫腔粘连评分的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。【结论】归肾丸加减联合人工周期能有效改善中、重度宫腔粘连患者术后的月经情况,降低粘连评分和中医证候积分,增加子宫内膜厚度,能有效预防TCRA术后再粘连,其疗效优于单独应用人工周期治疗。

Objective To observe the clinical efficacy of modified Guishen Pills combined with artificial periodic therapy for the treatment of post-operative adhesion after intrauterine adhesion(IUA).Methods Seventy-six patients with moderate and severe IUA of kidney deficiency and blood stasis type were randomly divided into observation group and control group,38 cases in each group.Patients in both groups were treated with transcervical resection of adhesion(TCRA),and additionally,the control group was treated only with artificial periodic therapy after TCRA and the observation group was treated with kidney-nourishing and blood-activating herbs derived from the modified Guishen Pills based on the treatment for the control group.The course of treatment lasted for 3 menstrual cycles.The endometrial thickness,IUA scores and traditional Chinese medicine(TCM)syndrome scores in the two groups were observed before and after treatment,and the clinical efficacy of the two groups was also evaluated.Results(1)After 3 menstrual cycles,the total effective rate of the observation group was 89.47%(34/38)and that of the control group was 78.95%(30/38).The intergroup comparison showed that the clinical efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the TCM syndrome scores in the two groups were significantly decreased compared to those before treatment(P<0.05),and the effect on decreasing TCM syndrome scores in the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(3)After treatment,the endometrial thickness in the patients of the two groups was significantly increased and the IUA scores were significantly decreased compared to those before treatment(P<0.05).The observation group had stronger effect on increasing the endometrial thickness and decreasing the IUA scores than the control group,the difference being statistically significant(P<0.05).Conclusion Modified Guishen Pills combined with artificial periodic therapy can effectively improve the postoperative menstruation of patients with moderate and severe IUA,reduce adhesion scores and TCM syndrome scores,increase endometrial thickness,and effectively prevent adhesion after TCRA.The effect of the combined therapy is stronger than the artificial periodic therapy alone.