1. 浙江省杭州市妇产科医院中医妇科,浙江,杭州,310008
2. 浙江省杭州市第一人民医院中医妇科,浙江,杭州,310006
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黄飞翔, 丁渊. 中药二联疗法联合GnRHa治疗腹腔镜术后子宫内膜异位症的疗效观察[J]. 上海中医药杂志, 2020,54(3):76-81.
HUANG Feixiang, DING Yuan. Observation on clinical effect of Chinese medicine double therapy combined with GnRHa in the treatment of endometriosis after laparoscopic surgery [J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(3):76-81.
黄飞翔, 丁渊. 中药二联疗法联合GnRHa治疗腹腔镜术后子宫内膜异位症的疗效观察[J]. 上海中医药杂志, 2020,54(3):76-81. DOI: 10.16305/j.1007-1334.2020.03.021.
HUANG Feixiang, DING Yuan. Observation on clinical effect of Chinese medicine double therapy combined with GnRHa in the treatment of endometriosis after laparoscopic surgery [J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(3):76-81. DOI: 10.16305/j.1007-1334.2020.03.021.
目的:探讨促性腺激素释放激素激动剂(GnRHa)联合补肾化瘀汤灌肠及抑更汤口服治疗子宫内膜异位症(endometriosis,EMT)腹腔镜术后患者的疗效。 方法:纳入EMT腹腔镜术后患者90例,按照分层分组方法随机分为4组,包括GnRHa组22例、GnRHa+灌肠组20例、GnRHa+抑更汤组26例、GnRHa+二联中药组22例。GnRHa组患者予抑那通皮下注射,GnRHa+灌肠组患者予抑那通皮下注射结合补肾化瘀汤保留灌肠,GnRHa+抑更汤组患者予抑那通皮下注射结合抑更汤口服,GnRHa+二联中药组予抑那通皮下注射、补肾化瘀汤保留灌肠及抑更汤口服。各组均以28 d为1个治疗周期,共治疗3个周期。治疗后随访1年,于术前、术后治疗后6个月、术后治疗后1年比较各组患者的痛经评分、中医证候评分;于术前及术后治疗后,检测所有患者的血清癌抗原125(CA125)、卵泡刺激素(FSH)、雌二醇(E,2,)水平,采用改良的Kupperman评分(K评分)评价患者的类绝经症状改善情况。 结果:①治疗后6个月及1年,各组患者的中医证候评分较术前均显著降低(P,<,0.05);治疗后1年,GnRHa组患者的中医证候评分较治疗后6个月明显升高(P,<,0.05)。治疗后6个月及1年,GnRHa+二联中药组、GnRHa+灌肠组患者的中医证候评分均低于GnRHa组、GnRHa+抑更汤组(P,<,0.05)。②治疗后6个月及1年,各组患者的痛经评分较术前均明显降低(P,<,0.05);治疗后1年,各组患者的痛经评分较治疗后6个月均升高(P,<,0.05)。治疗后6个月及1年,GnRHa+二联中药组、GnRHa+灌肠组患者的痛经评分均低于GnRHa组、GnRHa+抑更汤组(P,<,0.05)。③治疗后,各组患者的FSH、E,2,、CA125水平较术前均明显降低(P,<,0.05)。治疗后,各组患者的FSH水平比较,差异均无统计学意义(P,>,0.05);GnRHa组、GnRHa+灌肠组患者的E,2,水平均低于GnRHa+抑更汤组、GnRHa+二联中药组(P,<,0.05);GnRHa+二联中药组、GnRHa+灌肠组患者的CA125水平均低于GnRHa组、GnRHa+抑更汤组(P,<,0.05)。④治疗后,各组患者的K评分较术前均显著升高(P,<,0.05),且GnRHa组、GnRHa+灌肠组患者的K评分均高于GnRHa+抑更汤组、GnRHa+二联中药组(P,<,0.05)。 结论:四种治疗方案均可改善EMT患者的中医证候及痛经症状,降低患者的CA125水平;GnRHa联合补肾化瘀汤灌肠治疗能够更好地改善患者的中医证候及痛经评分,GnRHa联合抑更汤口服能更好地改善患者使用GnRHa后产生的类绝经症状;GnRHa联合补肾化瘀汤灌肠及抑更汤口服既能较好地改善EMT的临床症状,又能缓解患者的类绝经状态,值得在临床中推广应用。
Objective:To explore the therapeutic effect of GnRHa combined with Bushen Huayu Decoction coloclysis and Yigeng Decoction orally in treating patients with endometriosis (EMT) after laparoscopic surgery. MethodsNinety patients with EMT after laparoscopic surgery were enrolled and randomly divided into four groups, including 22 cases in GnRHa group, 20 cases in GnRHa + coloclysis group, 26 cases in GnRHa + Yigeng Decoction group, and 22 cases in GnRHa + Chinese medicine double therapy group, according to hierarchical method. The patients in the GnRHa group were given subcutaneous injection of enantone, the patients in the GnRHa + coloclysis group were given subcutaneous injection of enantone combined with Bushen Huayu Decoction coloclysis, the patients in the GnRHa + Yigeng Decoction group were given subcutaneous injection of enantone combined with Yigeng Decoction orally, and the patients in the GnRHa + Chinese medicine double therapy group were given subcutaneous injection of enantone combined with Bushen Huayu Decoction coloclysis and Yigeng Decoction orally. Twenty-eight days were a treatment course and all the patients were treated for 3 courses. Follow-up for 1 year after treatment, the dysmenorrhea scores and Chinese medical syndrome scores of all the groups were compared before surgery, 6 months and 1 year after treatment after surgery; the levels of serum cancer antigen (CA) 125, follicle stimulating hormone (FSH) and estradiol (E,2,) were detected, and the improvement of postmenopausal symptoms were evaluated by modified Kupperman score (K score) before surgery and after treatment after surgery. Results:①Six months and 1 year after treatment, the Chinese medical syndrome scores of all groups were obviously decreased compared with before surgery (P,<,0.05); 1 year after treatment, the Chinese medical syndrome score of the GnRHa group was significantly increased compared with 6 months after treatment (P,<,0.05). Six months and 1 year after treatment, the Chinese medical syndrome scores of the GnRHa + Chinese medicine double therapy group and GnRHa + coloclysis group were lower than those of the GnRHa group and GnRHa + Yigeng Decoction group (P,<,0.05). ②Six months and 1 year after treatment, the dysmenorrhea scores of all groups were obviously decreased compared with before surgery (P,<,0.05); 1 year after treatment, the dysmenorrhea scores of all groups were increased compared with 6 months after treatment (P,<,0.05). Six months and 1 year after treatment, the dysmenorrhea scores of the GnRHa + Chinese medicine double therapy group and GnRHa + coloclysis group were lower than those of the GnRHa group and GnRHa + Yigeng Decoction group (P,<,0.05). ③After treatment, the levels of FSH, E,2, and CA125 of all the groups were obviously decreased compared with before surgery (P,<,0.05). After treatment, there were no sigificant statistical differences on the level of FSH among all the groups (P,>,0.05); the levels of E,2, in the GnRHa group and GnRHa + coloclysis group were lower than those in the GnRHa + Yigeng Decoction group and GnRHa + Chinese medicine double therapy group (P,<,0.05); the levels of CA125 in the GnRHa + Chinese medicine double therapy group and GnRHa + coloclysis group were lower than those in the GnRHa group and GnRHa + Yigeng Decoction group (P,<,0.05). ④After treatment, the K scores of all the groups were obviously increased (P,<,0.05), and the K scores of the GnRHa group and GnRHa + coloclysis group were higher than those of the GnRHa + Yigeng Decoction group and GnRHa + Chinese medicine double therapy group (P,<,0.05). Conclusion:All the four therapeutic regimens can improve the Chinese medical syndrome and dysmenorrhea symptom, and decrease the level of CA125 in patients with EMT; GnRHa combined with Bushen Huayu Decoction coloclysis can better improve the Chinese medical syndrome and dysmenorrhea scores, and GnRHa combined with Yigeng Decoction orally can better improve the postmenopausal symptoms which were induced by the use of GnRHa; GnRHa combined with Bushen Huayu Decoction coloclysis and Yigeng Decoction orally can better improve the clinical symptoms of EMT, and relieve the postmenopausal symptoms, which is worthy popularization and application in clinic.
子宫内膜异位症腹腔镜术后补肾化瘀汤抑更汤GnRHa
endometriosisafter laparoscopic surgeryBushen Huayu decoctionYigeng DecoctionGnRHa
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