温胞饮加减方联合宫腹腔镜治疗输卵管性不孕的临床疗效研究

Clinical Efficacy of the Modified Wenbao Decoction Combined with Laparoscopic Surgery for the Treatment of Tubal Infertility

【目的】探讨温胞饮加减方联合宫腹腔镜治疗输卵管性不孕心肾阳虚型患者的临床疗效。【方法】将76例输卵管性不孕心肾阳虚型患者随机分为对照组和观察组,每组各38例。2组患者均在宫腹腔镜下行输卵管复通术,术后予常规预防感染治疗3 d。对照组术后第2个月开始,根据月经周期监测排卵,指导受孕;观察组在对照组的基础上于每次月经干净的第2天开始口服温胞饮加减方,14 d为1个疗程,连续服用3个月经周期。观察2组患者治疗前后血清炎症因子、中医证候积分及术后妊娠情况,并评价2组患者的中医证候疗效及临床疗效。【结果】(1)中医证候疗效方面,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71.05%(27/38),组间比较,观察组的中医证候疗效明显优于对照组(P<0.05)。(2)临床疗效方面,术后12个月内,观察组的总有效率为86.84%(33/38),对照组为65.79%(25/38),组间比较,观察组的临床疗效明显优于对照组(P<0.05)。(3)炎症因子方面,治疗后,2组患者血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平均较治疗前明显下降(P<0.01),且观察组对血清IL-6、TNF-α水平的下降作用均明显优于对照组(P<0.01)。(4)中医证候积分方面,经治疗3个月经周期,2组患者的中医证候积分均较治疗前下降(P<0.05),且观察组对中医证候积分的下降作用明显优于对照组,差异有统计学意义(P<0.05)。(5)妊娠方面,术后12个月内,观察组的宫内妊娠率为63.16%(24/38),对照组为39.47%(15/38),组间比较,观察组的术后宫内妊娠率优于对照组(P<0.05);观察组的受孕率为73.68%(29/38),对照组为60.52%(23/38),组间比较,观察组的术后受孕率优于对照组(P<0.05)。【结论】温胞饮加减方联合宫腹腔镜治疗输卵管性不孕心肾阳虚型患者,临床疗效显著,可有效抑制炎症反应,改善中医证候,提高宫内妊娠率及总受孕率。

Objective To investigate the clinical efficacy of the modified Wenbao Decoction combined with laparoscopic surgery for the treatment of tubal infertility(TI) in patients with heart-kidney yang deficiency syndrome. Methods Seventy-six cases of TI patients with heart-kidney yang deficiency syndrome were randomly divided into the control group and the observation group,with 38 cases in each group. Patients in both groups were treated with conventional infection-prevention therapy for 3 days after laparoscopic tubal revascularization. From the second month after surgery, the ovulation of the patients in the control group was monitored and their fertilization was guided according to the menstrual cycle. For the patients of the observation group, modified Wenbao Decoction was administered orally on the second day after the end of menstruation of each menstrual period on the basis of treatment for the control group. A total of 14 days constituted a course of treatment, and the treatment lasted for 3 consecutive menstrual cycles. The serum levels of inflammatory factors,traditional Chinese medicine(TCM)syndrome scores and postoperative pregnancy in the two groups were observed before and after treatment. Furthermore,the TCM syndrome efficacy and clinical efficacy of the two groups were evaluated. Results (1)After treatment for 3 menstrual cycles,the total effective rate for TCM syndrome efficacy in the observation group was 89.47%(34/38),and that in the control group was 71.05%(27/38). The intergroup comparison showed that the TCM syndrome efficacy in the observation group was significantly superior to that in the control group(P<0.05).(2)Within 12 months after surgery,the overall effective rate for clinical efficacy in the observation group was 86.84%(33/38),and that in the control group was 65.79%(25/38). The intergroup comparison showed that the clinical efficacy of the observation group was superior to that of the control group(P<0.05).(3)After treatment,the serum levels of inflammatory factors of interleukin 6(IL-6)and tumor necrosis factor α(TNF-α)in both groups were decreased significantly compared with those before treatment(P<0.01), and the effect on decreasing serum IL-6 and TNF-α levels in the observation group was significantly superior to that in the control group(P<0.01).(4)After treatment for 3 menstrual cycles, the TCM syndrome scores of both groups were decreased compared with those before treatment(P<0.05),and the effect on lowering the TCM syndrome scores in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(5)Twelve months after surgery,the intrauterine pregnancy rate in the observation group was 63.16%(24/38)and that in the control group was 39.47%(15/38), and the fertilization rate in the observation group was 73.68%(29/38) and that in the control group was 60.52%(23/38). The intergroup comparison showed that the intrauterine pregnancy rate and the fertilization rate in the observation group were superior to those in the control group(P<0.05). Conclusion The combination of modified Wenbao Decoction and laparoscopic surgery exerts significant therapeutic effect in treating tubal infertility patients with heart-kidney yang deficiency syndrome. The combined therapy is effective on suppressing the inflammatory response,improving the TCM syndrome and increasing the intrauterine pregnancy rate and the overall fertilization rate.