复方大血藤灌肠剂联合地屈孕酮治疗子宫腺肌病腹腔镜术后的临床疗效研究  

Clinical Efficacy of Compound Daxueteng Enema plus Dydrogesterone in Post-laparoscopic Adenomyosis Patients with Blood Stasis-heat Syndrome

作　　者：应翩[1] 王佳曦 杨华娣[1] 徐利[2] 陆申奕 吴燕平[1] YING Pian;WANG Jiaxi;YANG Huadi;XU Li;LU Shenyi;WU Yanping(Department of Gynecology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China;Department of Anorectal Surgery,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院妇科,浙江省杭州市310006 [2]浙江中医药大学附属第一医院肛肠科,浙江省杭州市310006

出　　处：《中国全科医学》2022年第18期2286-2290,共5页Chinese General Practice

基　　金：国家自然科学基金资助项目(82104909);浙江省自然科学基金资助项目(LQ20H270003);浙江省中医药科技计划项目(2020ZB098)。

摘　　要：背景子宫腺肌病(AM)是妇科难治性疑难病之一,发病机制尚不明确,个体化治疗目前被广泛重视,中西医结合治疗具有优势。目的观察复方大血藤灌肠剂联合地屈孕酮治疗AM腹腔镜术后的临床疗效。方法选取2019年1月至2020年8月在浙江省中医院经腹腔镜术后病理诊断确诊为AM且经中医辨证属瘀热互结型患者46例为研究对象,采用随机方法将患者分为治疗组(24例)和对照组(22例)。治疗组使用复方大血藤灌肠剂联合口服地屈孕酮;对照组仅口服地屈孕酮。疗程3个月,比较两组治疗前和治疗后临床综合疗效、中医症候评分、疼痛程度〔采用视觉模拟评分(VAS)进行评估〕、月经量评分〔采用失血量图形分析评分法(PBAC)进行评分〕、子宫体积、卵巢功能指标及血清糖类抗原125(CA125)情况。比较两组疗程结束后1年的远期治疗效果。结果治疗后,治疗组临床综合疗效优于对照组(u=2.140,P=0.032)。治疗后治疗组中医症候评分低于对照组(P<0.05)。两组治疗后VAS评分、PBAC评分、促黄体生成素(LH)、雌二醇(E2)、CA125低于治疗前,子宫体积小于治疗前(P<0.05)。治疗后治疗组VAS评分低于对照组,LH、CA125高于对照组,子宫体积小于对照组(P<0.05)。疗程结束后随访1年,治疗组复发率为20.8%(5例),妊娠率为8.3%(2例);对照组复发率为45.5%(10例),妊娠率为9.1%(2例),两组复发率、妊娠率比较,差异均无统计学意义(χ^(2)=3.166、0.008,P>0.05)。结论复方大血藤灌肠剂联合地屈孕酮治疗AM,能降低中医症候评分、缩小子宫体积,减轻疼痛,减少月经量,治疗效果优于单独使用地屈孕酮。Background Adenomyosis is a difficult-to-treat gynecological disease with unclear pathogenesis,individualized treatment for which is extensively valued,and the integrated traditional Chinese and western medicine treatment has been proven to have unique benefits merits.Objective To examine the clinical efficacy of compound Daxueteng enema plus dydrogesterone for post-laparoscopic adenomyosis patients with blood stasis-heat syndrome.Methods Participants(n=46)were selected from Zhejiang Provincial Hospital of Chinese Medicine during January 2019 to August 2020.All of them received laparoscopic surgery,and were diagnosed with adenomyosis by pathological examination of the surgical specimen,and with blood stasis-heat syndrome by TCM syndrome differentiation.For comparing the effects of two types of postsurgical treatments lasting for three months,they were randomized into a control group(n=22)and a treatment group(n=24),receiving oral dydrogesterone,and oral dydrogesterone plus compound Daxueteng enema,respectively.TCM syndrome score,pain level(VAS score),menstrual blood loss(PBAC score),uterine volume,ovarian function parameters and serum CA125 were measured at baseline and the end of the three-month treatment.The overall efficacies of two groups were assessed at the end of treatment,and one year after the treatment,respectively.Results The treatment group had statistically higher overall three-month efficacy than the control group(u=2.140,P=0.032).TCM syndrome score of the treatment group were lower than the control group(P<0.05).After treatment,the VAS score,PBAC score uterine volume,LH,E2 and CA125 showed a statistical decrease in both groups(P<0.05).And the VAS score,uterine volume,demonstrated decreases,LH and CA125 demonstrated better improvements in the treatment group than the control group(P<0.05).One-year post-treatment follow-up revealed that treatment group and control group had no statistically significant differences in recurrence rate〔20.8%(5 cases)vs 45.5%(10 cases)〕(χ^(2)=3.166,P>0.05),and pregn

关 键 词：子宫腺肌病 复方大血藤灌肠剂 地屈孕酮 临床疗效 

分 类 号：R711.71[医药卫生—妇产科学]