本文選題：補腎祛瘀法 + 子宮內(nèi)膜異位癥術(shù)后��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的觀察補腎祛瘀法聯(lián)合GnRH-a治療內(nèi)異癥腹腔鏡術(shù)后患者治療前后腎、血瘀的積分和分級的改變情況,以及治療后1年內(nèi)的復(fù)發(fā)情況、受孕情況,明確補腎祛瘀法聯(lián)合GnRH-a治療內(nèi)異癥腹腔鏡術(shù)后患者的臨床療效。方法選取2014年12月～2016年1月就診我院婦科病房住院的內(nèi)異癥腹腔鏡術(shù)后應(yīng)用GnRH-a有生育要求的腎虛血瘀證患者為研究對象,隨機分為中藥組、對照組,每組各30例。兩組均于術(shù)后月經(jīng)來潮第1天開始注射醋酸亮丙瑞林,每28天一針,共三針。中藥組在每次注射醋酸亮丙瑞林后第1天起服用補腎祛瘀方,連服21天為一個療程,共3個療程。對照組不予其他處理,若患者血管舒縮綜合征癥狀明顯,予谷維素口服,一次1片,一日3次。于注射第3針后的28天進(jìn)行療效評估,觀察兩組患者治療前后腎、血瘀積分及分級的改變情況。隨訪觀察兩組患者治療后不同時期的B超檢查結(jié)果、VAS評分表、血清CA125水平以及患者治療后1年內(nèi)的復(fù)發(fā)情況、受孕情況,并運用統(tǒng)計軟件對數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)處理,分析比較兩種療法對內(nèi)異癥腹腔鏡術(shù)后應(yīng)用GnRH-a治療的臨床療效差異。結(jié)果1.兩組患者在治療后半年內(nèi)B超復(fù)發(fā)情況差異無統(tǒng)計學(xué)意義(P0.05);中藥組患者治療后一年內(nèi)B超復(fù)發(fā)率低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。2.兩組患者于治療后半年痛經(jīng)、盆腔痛、性交痛的VAS評分情況差異無統(tǒng)計學(xué)意義(P0.05);中藥組在治療后一年痛經(jīng)、盆腔痛、性交痛的VAS評分情況均明顯低于對照組,差異有顯著的統(tǒng)計學(xué)意義(P0.01)。3.兩組患者于注射第3針亮丙瑞林后的28天的血清CA125水平差異無統(tǒng)計學(xué)意義(P0.05);中藥組在治療后半年、治療后一年血清CA125水平明顯低于對照組,差異有顯著的統(tǒng)計學(xué)意義(P0.01)。4.中藥組患者治療后一年內(nèi)復(fù)發(fā)率低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。5.中藥組患者治療后一年內(nèi)受孕率高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。6.兩組患者在治療前腎、血瘀積分情況差異無統(tǒng)計學(xué)意義(P0.05)。經(jīng)過治療后,中藥組腎、血瘀積分和分級均較治療前明顯降低,且療效明顯優(yōu)于對照組(P0.01);而對照組經(jīng)過治療后腎積分和分級較治療前明顯升高,血瘀積分和分級與治療前對比相對降低。結(jié)論1補腎祛瘀法能夠緩解內(nèi)異癥患者痛經(jīng)、盆腔痛、性交痛的疼痛程度;2補腎祛瘀法可在一定程度上降低血清CA125水平和B超復(fù)發(fā)率,從而減少內(nèi)異癥的復(fù)發(fā);3補腎祛瘀法在一定程度上可以改善內(nèi)異癥患者的受孕率,提高生育能力;4補腎祛瘀法可降低內(nèi)異癥腹腔鏡術(shù)后應(yīng)用GnRH-a的腎、血瘀積分和分級,增強患者對GnRH-a的耐受性。
[Abstract]:Objective to observe the changes of renal and blood stasis score and grade before and after treatment with GnRH-a combined with tonifying the kidney and removing blood stasis in patients with endoscopes after laparoscopic surgery, as well as the recurrence and pregnancy in one year after treatment. To determine the clinical efficacy of tonifying kidney and removing blood stasis combined with GnRH-a in patients with endodysm after laparoscopic surgery. Methods from December 2014 to January 2016, patients with kidney deficiency and blood stasis syndrome with GnRH-a were randomly divided into Chinese medicine group (n = 30) and control group (n = 30). On the first day of menstrual onset, the two groups received three injections of Leuprilline Acetate every 28 days. The traditional Chinese medicine group took Bushen Quyu decoction on the first day after each injection of Leuprorelin Acetate, taking 21 days as a course of treatment for 3 courses. In the control group, if the symptoms of vasomotor syndrome were obvious, oryzanol was given orally, 1 tablet once, 3 times a day. The curative effect was evaluated 28 days after the third injection, and the changes of kidney, blood stasis score and grading were observed before and after treatment. The results of B-ultrasound examination in different periods after treatment were followed up. The scores of VAS, the level of serum CA125, the recurrence of the patients within one year after treatment, and the conception of the patients were observed. The data were analyzed by statistical software. To analyze and compare the clinical curative effect of two kinds of therapy in treating endoscopes after laparoscopic operation with GnRH-a. Result 1. There was no significant difference in the recurrence of B-ultrasound between the two groups within half a year after treatment, while the recurrence rate of B-ultrasound in the Chinese medicine group was lower than that in the control group within one year after treatment, and the difference was statistically significant. There was no significant difference in VAS scores of dysmenorrhea, pelvic pain and sexual intercourse pain between the two groups half a year after treatment. The VAS scores of dysmenorrhea, pelvic pain and sexual intercourse pain in the Chinese medicine group were significantly lower than those in the control group one year after treatment. The difference was statistically significant (P 0.01. 3). There was no significant difference in serum CA125 level between the two groups at 28 days after the third injection of Leurelin, but the serum CA125 level in the traditional Chinese medicine group was significantly lower than that in the control group half a year after treatment and one year after treatment, and the difference was statistically significant. The recurrence rate in the Chinese medicine group was lower than that in the control group within one year after treatment, and the difference was statistically significant (P 0.05). The pregnancy rate in the Chinese medicine group within one year after treatment was higher than that in the control group, and the difference was statistically significant (P 0.05. 6). There was no significant difference in blood stasis score between the two groups before treatment (P 0.05). After treatment, the renal blood stasis score and grade of the Chinese medicine group were significantly lower than those of the control group, and the curative effect was obviously better than that of the control group (P 0.01), while the renal score and grade in the control group were significantly higher than those before the treatment. Blood stasis score and grading were relatively lower than those before treatment. Conclusion (1) the method of tonifying kidney and removing blood stasis can relieve the pain degree of dysmenorrhea, pelvic pain and sexual intercourse pain in patients with endodonosis. The method of tonifying kidney and removing blood stasis can reduce the level of serum CA125 and the recurrence rate of B-ultrasound to a certain extent. Therefore, the method of reducing the recurrence of endometriosis and eliminating kidney and blood stasis can improve the pregnancy rate of patients with endodysm to a certain extent, and improve the fertility of patients with endometriosis. The method of tonifying kidney and removing blood stasis after laparoscopy can reduce the score and grade of kidney, blood stasis and blood stasis of GnRH-a after laparoscopy. Enhance patient's tolerance to GnRH-a.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.71

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