复元祛瘀汤联合雌孕激素序贯疗法预防宫腔镜下宫腔粘连分离术后再粘连临床研究

Clinical Study on Fuyuan Quyu Decoction Combined with Sequential Estrogen and Progestogen Therapy for Preventing Re-adhesion After Hysteroscopic Separation of Intrauterine Adhesions

目的:观察复元祛瘀汤联合雌孕激素序贯疗法预防宫腔镜下宫腔粘连分离术后再粘连的临床疗效。方法:纳入宫腔镜下宫腔粘连分离术后辨证属肾虚血瘀证的60例患者,随机分为观察组和对照组各30例。2组均予雌孕激素序贯疗法治疗,观察组加予复元祛瘀汤治疗,2组均治疗3个月经周期。治疗前、治疗3个月经周期后评定宫腔粘连评分、中医证候积分、腹部的疼痛视觉模拟评分法(VAS)评分,检测子宫内膜厚度、宫腔容积、阻力指数(RI)、搏动指数(PI)、血流指数(FI),比较2组的临床疗效与治疗过程中的不良反应发生率。治疗3个月经周期后随访3个月,统计2组的再粘连发生率。结果:治疗后,观察组临床疗效总有效率高于对照组(P<0.05)。2组宫腔粘连评分、中医证候积分、VAS评分均较治疗前降低(P<0.05),观察组宫腔粘连评分、中医证候积分、VAS评分均低于对照组(P<0.05)。2组子宫内膜厚度、宫腔容积、FI值均较治疗前增加(P<0.05),RI、PI值均较治疗前降低(P<0.05)。观察组子宫内膜厚度、宫腔容积、FI值均高于对照组(P<0.05),RI、PI值均低于对照组(P<0.05)。观察组不良反应发生率、再粘连发生率均低于对照组(P<0.05)。结论:运用复元祛瘀汤联合雌孕激素序贯疗法干预宫腔粘连术后患者,能够有效地促进子宫内膜修复、宫腔形态恢复,促进月经恢复正常,减轻粘连,改善中医证候,缓解疼痛,降低子宫血管阻力,恢复子宫血管血流灌注,有效预防术后再粘连,安全性高。

Objective:To observe the clinical effect of the therapy of Fuyuan Quyu Decoction combined with sequential estrogen and progestogen therapy on preventing re-adhesion after hysteroscopic separation of intrauterine adhesion.Methods:A total of 60 patients with syndrome of kidney deficiency and blood stasis based on syndrome differentiation after receiving hysteroscopic separation of intrauterine adhesions were included and randomly divided into the observation group and the control group,with 30 cases in each group.The two groups were given the sequential estrogen and progesterone therapy for treatment,based on which the observation group was additionally treated with Fuyuan Quyu Decoction.Both groups were treated for three menstrual cycles.Before treatment and after three menstrual cycles of treatment,the scores of intrauterine adhesion,traditional Chinese medicine(TCM)syndrome and Visual Analogue Scale(VAS)of abdominal pain were evaluated;the endometrial thickness,uterus cavity volume,resistance index(RI),pulsitility index(PI)and flow index(FI)were detected;the clinical effects and incidence of adverse reactions during treatment were compared between the two groups.After three menstrual cycles of treatment,the two groups were followed up for three months,and the incidence of re-adhesion in both groups were counted.Results:After treatment,the total clinical effective rate in the observation group was higher than that in the control group(P<0.05).The scores of intrauterine adhesion,TCM syndrome and VAS in both groups were decreased when compared with those before treatment(P<0.05),and the above three scores in the observation group were lower than those in the control group(P<0.05).The endometrial thickness,uterus cavity volume and FI values in the two groups were increased when compared with those before treatment(P<0.05),and the values of RI and PI were decreased when compared with those before treatment(P<0.05).The endometrial thickness,uterus cavity volume and FI value in the observation group were higher than those in the control group(P<0.05),and the values of RI and PI were lower than those in the control group(P<0.05).The incidence of adverse reactions and re-adhesion were respectively lower than those in the control group(P<0.05).Conclusion:The application of Fuyuan Quyu Decoction combined with sequential estrogen and progesterone therapy as the intervention for patients after intrauterine adhesion surgery can effectively promote the endometrial repair,and recovery of uterine cavity shape and normal menstruation,reduce adhesion,improve the TCM syndrome,mitigate pain,decrease the vascular resistance of uterus,and recover the vascular blood perfusion of uterus,thus effectively preventing the re-adhesion after intrauterine adhesion surgery with good safety.