本文選題：子宮內(nèi)膜異位癥 + 保守手術(shù)后��； 參考：《河北大學(xué)》2017年碩士論文

【摘要】：目的通過觀察子宮內(nèi)膜異位癥保守手術(shù)后的患者應(yīng)用中成藥桂枝茯苓丸鞏固治療與術(shù)后應(yīng)用西藥促性腺激素釋放激素激動(dòng)劑(GnRH-a)鞏固治療的患者,在臨床癥狀、療效、復(fù)發(fā)情況及藥物不良反應(yīng)上的優(yōu)劣,研究桂枝茯苓丸治療子宮內(nèi)膜異位癥保守手術(shù)后的臨床優(yōu)勢。方法選取2015年1月至2016年9月,河北大學(xué)附屬醫(yī)院收治的首次開腹或腹腔鏡保守手術(shù),且經(jīng)術(shù)后病理證實(shí)為子宮內(nèi)膜異位癥的患者共60例。采取隨機(jī)法,將術(shù)后患者隨機(jī)分為中藥組(30例)、西藥組(30例);另外選取子宮內(nèi)膜異位癥保守手術(shù)后,向患者建議應(yīng)用藥物鞏固治療,但拒絕應(yīng)用并簽字者作為對照組(30例)。中藥組術(shù)后給與口服中成藥“桂枝茯苓丸”,6g/次,2次/日,治療3個(gè)月(經(jīng)期及經(jīng)后3天停用);西藥組給與GnRH-a:皮下注射“醋酸亮丙瑞林”3.75mg/次,1次/28天,治療3個(gè)療程;對照組術(shù)后拒絕應(yīng)用任何藥物鞏固治療。比較三組患者在術(shù)后痛經(jīng)評分改變、血清CA125降低情況、臨床療效、復(fù)發(fā)情況及藥物不良反應(yīng)上的差異。結(jié)果術(shù)后3個(gè)月的痛經(jīng)評分程度(中藥組輕度5例,中度3例,重度0例;西藥組輕度5例,中度1例,重度0例;對照組輕度9例,中度6例,重度0例),無統(tǒng)計(jì)學(xué)差異(P0.05)。但術(shù)后半年的痛經(jīng)評分程度(中藥組輕度6例,中度3例,重度0例;西藥組輕度5例,中度1例,重度0例;對照組輕度12例,中度6例,重度0例),存在統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后3個(gè)月的血清CA125的降低例數(shù)(中藥組為28例,西藥組為29例,對照組25例),無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后半年的血清CA125的降低例數(shù)(中藥組為26例,西藥組為28例,對照組21例),存在統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后3個(gè)月中醫(yī)組的有效率(66.67%)、緩解率(33.33%)、復(fù)發(fā)率(0.00%),西醫(yī)組的有效率(76.67%)、緩解率(23.33%)、復(fù)發(fā)率(0.00%),對照組的有效率(66.67%)、緩解率(30.00%)、復(fù)發(fā)率(3.33%),無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后半年中醫(yī)組的有效率(73.33%)、緩解率(23.33%)、復(fù)發(fā)率(3.33%),西醫(yī)組的有效率(80.00%)、緩解率(20.00%)、復(fù)發(fā)率(0.00%),對照組的有效率(56.67%)、緩解率(26.67%)、復(fù)發(fā)率(16.67%),存在統(tǒng)計(jì)學(xué)差異(P0.05)。在藥物不良反應(yīng)方面,其中在肝腎功能損害上中藥組(4例)、西藥組(5例)、對照組(0例)無統(tǒng)計(jì)學(xué)差異(P0.05),但中藥組及對照組在潮熱、閉經(jīng)及陰道出血的發(fā)生例數(shù)上明顯低于西藥組(中藥組分別為8例、4例、7例,西藥組分別為15例、11例、16例,對照組分別為5例、3例、8例),結(jié)果均存在統(tǒng)計(jì)學(xué)上差異(P0.05)。結(jié)論子宮內(nèi)膜異位癥保守手術(shù)后進(jìn)一步給予桂枝茯苓丸鞏固治療的患者與術(shù)后給予醋酸亮丙瑞林鞏固治療的患者,在痛經(jīng)評分的變化、血清CA125降低情況、臨床療效上均無明顯差異,但是均明顯優(yōu)于未給予鞏固治療者,表明子宮內(nèi)膜異位癥保守術(shù)后進(jìn)一步給予桂枝茯苓丸鞏固治療后的患者自覺癥狀、化驗(yàn)指標(biāo)、臨床有效率及術(shù)后復(fù)發(fā)率上均有較好的效果,且與術(shù)后應(yīng)用醋酸亮丙瑞林鞏固治療無明顯差異;但應(yīng)用桂枝茯苓丸進(jìn)行鞏固治療的藥物不良反應(yīng)的發(fā)生率明顯低于應(yīng)用醋酸亮丙瑞林進(jìn)行鞏固治療,尤其是明顯降低了患者術(shù)后出現(xiàn)潮熱、閉經(jīng)及陰道出血的發(fā)生率,說明桂枝茯苓丸在子宮內(nèi)膜異位癥保守術(shù)后的鞏固治療上存在優(yōu)勢,值得進(jìn)行臨床推廣。
[Abstract]:Objective To observe the clinical symptoms, curative effect, recurrence and adverse drug reaction in patients with the consolidation therapy of Guizhi Fuling pill (Guizhi Fuling pill) after the conservative operation of endometriosis after the conservative operation of the Chinese patent medicine Guizhi Fuling pill (GnRH-a), and to study the treatment of cinnamon tuckahoe pill in the uterus. The clinical advantages of conservative surgery were selected from January 2015 to September 2016. The first laparotomy or laparoscopic conservative surgery in the Affiliated Hospital of Hebei University was selected, and 60 patients with endometriosis confirmed by postoperative pathology were randomly divided into Chinese medicine group (30 cases) and Western medicine group (30 cases). After the conservative operation of endometriosis was selected, the drug consolidation therapy was recommended to the patients, but the patients were refused and signed as the control group (30 cases). The Chinese traditional medicine group was given the Chinese traditional Chinese medicine "Guizhi Fuling pill", 6g/ times, 2 times, treatment for 3 months (menstrual and 3 days after the menstruation); the western medicine group gave the subcutaneous injection of "acetic acid bright". Proprolin "3.75mg/ times, 1 /28 days, treatment for 3 courses, the control group refused to use any drug consolidation treatment after operation. Compare the changes of dysmenorrhea score, serum CA125 reduction, clinical efficacy, recurrence and drug adverse reactions in the three groups. Results the degree of dysmenorrhea score of 3 months after the operation (5 cases of Chinese medicine group, moderate to moderate) 3 cases, severe 0 cases, western medicine group mild 5 cases, moderate 1 cases, severe 0 cases, control group 9 cases, moderate 6 cases, severe 0 cases, no statistical difference (P0.05), but the degree of dysmenorrhea score (6 in the Chinese medicine group, moderate 3, severe 0, moderate 1 cases, moderate serious 0 cases in the western medicine group, mild cases in the control group, moderate cases, severe cases), Statistical difference (P0.05). The number of serum CA125 decreased in 3 months after operation (28 cases in Chinese medicine group, 29 in western medicine group and 25 in control group). There was no statistical difference (P0.05). There were 26 cases of serum CA125 in six months after operation (26 cases of traditional Chinese medicine group, 28 cases in western medicine group and 21 cases in control group), and there were statistical differences (P0.05). The effectiveness of traditional Chinese medicine group was effective 3 months after operation. Rate (66.67%), remission rate (33.33%), recurrence rate (0%), the effective rate (76.67%), remission rate (23.33%), recurrence rate (0%), the efficiency (66.67%) of the control group (66.67%), the remission rate (30%), the recurrence rate (3.33%), and no statistical difference (P0.05). The effective rate (73.33%), relapse rate (23.33%), recurrence rate (3.33%), and the effectiveness of Western medicine group were effective six months after the operation. Rate (80%), the rate of remission (20%), the rate of recurrence (0%), the efficiency of the control group (56.67%), the remission rate (26.67%), the recurrence rate (16.67%), and there was a statistical difference (P0.05). In the adverse drug reactions, the liver and kidney function damage in the Chinese medicine group (4 cases), the western medicine group (5 cases), and the control group (0 cases) had no statistical difference (P0.05), but the traditional Chinese medicine group and the control group were in the control group (0 cases). The number of cases of tidal fever, amenorrhea and vaginal bleeding were significantly lower than that of the western medicine group (8 cases, 4 cases, 7 cases respectively, 15 cases in the western medicine group, 11 cases, 16 cases respectively, 5 cases, 3 cases, 8 cases respectively), and the results were statistically different (P0.05). Conclusion after conservative operation of endometriosis, it was further given the consolidation therapy of Guizhi Fuling pill. There was no significant difference in the clinical efficacy between the patients and the patients who had been treated with bright propane acetate, the changes in the dysmenorrhea score, the decrease in the serum CA125 and the clinical efficacy, but all of them were obviously better than those without the consolidation therapy. The test index, clinical efficiency and postoperative recurrence rate have good results, and there is no significant difference with the postoperative application of Leucin acetate consolidation therapy. However, the incidence of adverse drug reactions with cinnamon Fuling pill for consolidation therapy is obviously lower than that of bright propane acetate. The incidence of hot flashes, amenorrhea and vaginal bleeding shows that Guizhi Fuling pill has advantages in the consolidation of endometriosis after conservative surgery. It is worthy of clinical promotion.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R713.4

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