“行水通歧方”联合宫腹腔镜治疗输卵管积水性不孕的临床观察  

Clinical Observation on the Xingshui Tongqi Prescription Combined with Hysterolaparoscopy in the Treatment of Hydrosalpinx-caused Infertility

作　　者：钟钰 曾元青 冯婉莹 叶敦敏 ZHONG Yu;ZENG Yuan-Qing;FENG Wan-Ying;YE Dun-Min(The Third Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510375 Guangdong,China)

机构地区：[1]广州中医药大学第三临床医学院,广东广州510405 [2]广州中医药大学第三附属医院,广东广州510375

出　　处：《广州中医药大学学报》2023年第11期2778-2785,共8页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】观察“行水通歧方”(基于益气健脾、行气利水、活血通络法,以四君子汤为基础化裁而成)联合宫腹腔镜(宫腹腔镜联合探查术下行输卵管造口术)治疗输卵管积水性不孕患者的临床疗效。【方法】回顾性分析102例输卵管积水性不孕气滞湿阻证患者,根据术后有无服中药分为治疗组53例和对照组49例。对照组于宫腹腔镜下行输卵管伞端电凝成型术,术毕予丹参注射液冲洗盆腔;治疗组在对照组的基础上术后加用“行水通歧方”治疗,至少服用3个月经周期。观察术后1年内2组患者妊娠结局、未妊娠输卵管积水复发率及治疗前后中医证候评分、血清抗苗勒氏管激素(AMH)水平、子宫内膜厚度、子宫动脉搏动指数(PI)、子宫动脉阻力指数(RI)的变化情况,并根据术后妊娠结局,找出影响术后妊娠的相关因素。【结果】(1)妊娠结局及未妊娠输卵管积水复发情况:治疗组宫内妊娠率为71.7%(38/53),高于对照组的32.7%(16/49),差异有统计学意义(P<0.05);治疗组异位妊娠率为7.5%(4/53),低于对照组的16.3%(8/49),但差异无统计学意义(P>0.05);治疗组宫内妊娠患者辅助生殖技术(ART)助孕成功率为31.6%(12/38),对照组为37.5%(6/16),差异无统计学意义(P>0.05);治疗组未妊娠输卵管积水复发率为18.2%(2/11),明显低于对照组的60.0%(15/25),差异有统计学意义(P<0.05)。(2)中医证候评分情况:治疗后,2组患者的中医证候积分均较治疗前下降(P<0.05),且治疗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)。(3)卵巢储备功能情况:治疗后,2组患者的血清AMH水平均较治疗前升高(P<0.05),且治疗组对血清AMH水平的升高作用明显优于对照组,差异有统计学意义(P<0.05)。(4)子宫内膜容受性情况:治疗后,2组患者的子宫内膜厚度均较治疗前升高(P<0.05),PI、RI值均较治疗前下降(P<0.05),且治疗组对子宫内膜厚度的升�Objective To observe the clinical efficacy of Xingshui Tongqi Prescription(derived from the modified Sijunzi Decoction following the therapy of replenishing qi and strengthening the spleen,moving qi and inducing diuresis,and activating blood and unblocking collaterals)combined with salpingostomy under hysterolaparoscopy for the treatment of patients with hydrosalpinx-caused infertility.Methods A retrospective analysis of 102 patients with hydrosalpinx-caused infertility differentiated as qi stagnation and dampness obstruction syndrome was conducted.The patients were divided into 53 cases in the treatment group and 49 cases in the control group according to the medication or no medication of Chinese medicines after the operation.The control group was given electrocoagulation of the umbilical end of the fallopian tube under hysterolaparoscopy,and then was given pelvic irrigation with Danshen Injection after the operation.The treatment group was given Xingshui Tongqi Prescription orally for at least 3 menstrual cycles based on the treatment for the control group.We monitored the pregnancy outcome and the recurrence rate of non-pregnant hydrosalpinx in the first year after the operation,and observed the changes in traditional Chinese medicine(TCM)syndrome scores,serum anti-Mullerian hormone(AMH)level,endometrial thickness,uterine artery pulsatility index(PI),and uterine artery resistance index(RI)in the two groups before and after treatment.Moreover,the factors affecting the pregnancy were identified according to the pregnancy outcome after the operation.Results(1)During the first year after the operation,the rate of intrauterine pregnancy in the treatment group was 71.7%(38/53),higher than that of 32.7%(16/49)in the control group,and the difference was statistically significant(P<0.05);the rate of ectopic pregnancy in the treatment group was 7.5%(4/53),lower than that of 16.3%(8/49)in the control group,but the difference was not statistically significant(P>0.05).The success rate of assisted reproductive technology(A

关 键 词：输卵管积水性不孕 气滞湿阻证 宫腹腔镜联合探查术 输卵管造口术 “行水通歧方” 益气健脾 行气利水 活血通络 四君子汤 卵巢储备功能 子宫内膜容受性 宫内妊娠率 

分 类 号：R271.14[医药卫生—中医妇科学]