【摘要】：目的：本課題的研究旨在通過觀察輸卵阻塞性不孕癥患者經(jīng)腹腔鏡術(shù)后中醫(yī)藥治療與單純行腹腔鏡術(shù)后的臨床療效,分析手術(shù)兩組病例治療前后血清腫瘤壞死因子(TNF-α)水平、術(shù)后輸卵管再通率、妊娠率以及中醫(yī)癥狀、局部體征的改善情況,以期為輸卵管積水不孕患者提供切實可行的治療手段。 方法：將60例符合中西醫(yī)診斷標準的輸卵管積水不孕患者,隨機分為治療組30例(腹腔鏡手術(shù)配合中藥治療)和對照組30例(單純手術(shù)治療)。治療組于術(shù)后連續(xù)口服中藥3個月,并隨訪6月。治療前后對上訴兩組分別進行安全性觀察以及療效性檢測。觀察兩組治療前后妊娠率、中醫(yī)證候、局部體征表現(xiàn)及腫瘤壞死因子α等理化指標變化情況,比較兩組治療后組間的差異。 結(jié)果：1.采用腹腔鏡手術(shù)聯(lián)合中藥口服治療較單純運用腹腔鏡手術(shù)治療對患者術(shù)后9個月內(nèi)的受孕率具有顯著差異(P0.05)；2.即使未能成功受孕,中藥聯(lián)合腹腔鏡治療相比于單純腹腔鏡治療可獲得更高的輸卵管通暢率(P0.01)；3.治療后中醫(yī)證候療效進行比較,中藥聯(lián)合腹腔鏡組總有效率達到90.0%,顯著優(yōu)于單純腹腔鏡治療組的80%有效率(P0.05)。4.兩種治療方法均能夠使輸卵管阻塞性不孕癥患者的局部體征得到明顯改善,中藥聯(lián)合腹腔鏡治療組與單純腹腔鏡治療組總有效率分別為93.33%、76.67%,兩組間療效相比,中藥聯(lián)合治療組的優(yōu)勢更為顯著(P0.05)。5.中藥聯(lián)合腹腔鏡治療與單純腹腔鏡治療均可顯著降低治療前血清TNF-a水平(P0.01),但兩者相比,中藥聯(lián)合組對TNF-α的降調(diào)影響更為顯著(P0.01)。6.安全性分析：血常規(guī)、尿常規(guī)、糞便常規(guī)、肝腎功能、常規(guī)心電圖檢測在治療組30例患者用藥前后的均無異常,提示該療法無明顯不良反應及毒副作用。 結(jié)論：1.腹腔鏡手術(shù)能夠有效通過松解盆腔的局部粘連、恢復輸卵管卵巢正常的解剖結(jié)構(gòu),達到糾正輸卵管阻塞的治療目的；2.中藥治療對該病具有顯著效果,體現(xiàn)在其所具有的綜合療效、證候療效、局部體征療效等多個方面,其作用機制可能與藥物調(diào)節(jié)患者輸卵管局部炎性因子,如TNF-α的水平,進而減輕炎性反應,減少水腫及纖維素樣滲出,降低或延緩輸卵管粘連可能,并通過改善盆腔局部血流、抑菌殺菌、鎮(zhèn)痛解痙等有關功效,共同達到治療目的；3.腹腔鏡手術(shù)后結(jié)合中藥可以顯著提高對臨床癥狀、體征的改善程度,減輕患者不適,提供更好的受孕環(huán)境。
[Abstract]:Objective: the purpose of this study was to observe the clinical effects of traditional Chinese medicine (TCM) and laparoscopic surgery (Laparoscopic only) in patients with obstructive infertility after oocyte transfusion, and to analyze the serum levels of tumor necrosis factor (TNF- 偽) before and after treatment in two groups of patients. The rate of fallopian tube recanalization, pregnancy rate and the improvement of symptoms and local signs of traditional Chinese medicine were discussed in order to provide practical treatment for infertile patients with hydrosalpinx. Methods: sixty infertile patients with hydrosalpinx were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group was treated with oral Chinese medicine for 3 months and followed up for 6 months. The safety and efficacy of the two groups were observed before and after treatment. The changes of pregnancy rate, TCM syndromes, local physical signs and tumor necrosis factor 偽 (TNF- 偽) were observed before and after treatment, and the differences between the two groups were compared. The result is 1: 1. Laparoscopic surgery combined with oral Chinese medicine treatment compared with the use of laparoscopic surgery alone in 9 months after the pregnancy rate of patients with significant differences (P0.05). 2. Even if it failed to conceive successfully, the rate of tubal patency (P0.01) in combination with laparoscopy was higher than that in laparoscopy alone (P0.01). After treatment, the total effective rate of traditional Chinese medicine combined with laparoscopy group reached 90.0, significantly better than the 80% effective rate of simple laparoscopic treatment group (P0.05). 4. The local physical signs of patients with oviduct obstructive infertility were significantly improved by both methods. The total effective rates of the Chinese medicine combined with laparoscopy group and the simple laparoscopic treatment group were 93.33 and 76.67, respectively. The curative effect was compared between the two groups. The advantages of traditional Chinese medicine combined treatment group were more significant (P0.05). Compared with traditional Chinese medicine combined with laparoscopic therapy and laparoscopic therapy alone, serum TNF-a level was significantly decreased (P0.01), but the effect of TCM-combined group on TNF- 偽 was more significant (P0.01) .6. Safety analysis: blood routine, urine routine, stool routine, liver and kidney function, routine electrocardiogram were not abnormal in 30 cases of treatment group before and after treatment, indicating that the treatment has no obvious adverse reactions and side effects. Conclusion 1. Laparoscopic surgery can effectively release local adhesions of the pelvic cavity and restore the normal anatomical structure of the oviduct and ovary, and achieve the purpose of correcting the obstruction of the fallopian tube. Traditional Chinese medicine treatment has remarkable effect on the disease, which is reflected in its comprehensive curative effect, syndromes curative effect, local sign curative effect and so on. The mechanism of its action may be related to the level of local inflammatory factors, such as TNF- 偽. It is possible to reduce inflammatory reaction, reduce edema and fibrous exudation, decrease or delay fallopian tube adhesion, and through improving pelvic local blood flow, bacteriostasis, analgesia and spasmolysis, etc. Laparoscopy combined with traditional Chinese medicine can significantly improve the clinical symptoms and signs, reduce the discomfort of patients, and provide a better pregnant environment.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.6

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