【摘要】：目的：通過觀察中藥定經(jīng)湯加味對腎虛血瘀型子宮內(nèi)膜息肉宮腔鏡術(shù)后患者的月經(jīng)、中醫(yī)證候、息肉復(fù)發(fā)情況的作用,評價中藥在防治子宮內(nèi)膜息肉方面的效果及臨床優(yōu)勢。方法：收集符合納入標(biāo)準(zhǔn)的94例病例,隨機分為中藥組31例、西藥組32例和對照組31例。中藥組于宮腔鏡術(shù)后每次月經(jīng)周期第8天開始服用中藥定經(jīng)湯加味,連續(xù)服用14天(手術(shù)當(dāng)月,術(shù)后即開始服用),西藥組于宮腔鏡術(shù)后每次月經(jīng)周期第16天開始服用地屈孕酮片(手術(shù)當(dāng)月亦按周期服用),連續(xù)服用10天,每個月經(jīng)周期為1個療程,共治療3個療程；對照組為單純的手術(shù)組。通過記錄患者的中醫(yī)證候、子宮內(nèi)膜厚度以及子宮內(nèi)膜息肉復(fù)發(fā)情況,評價各組患者術(shù)后第3個月經(jīng)周期及第6個月經(jīng)周期的調(diào)經(jīng)效果、臨床療效。最后將記錄的數(shù)據(jù)通過SPSS17.0軟件包進行統(tǒng)計學(xué)分析。結(jié)果：1.宮腔鏡手術(shù)前,三組患者的年齡、中醫(yī)主要癥狀積分、次要癥狀積分、癥狀總積分、病情分布及子宮內(nèi)膜厚度,經(jīng)統(tǒng)計學(xué)分析無顯著性差異(P0.05),說明三組之間符合統(tǒng)計學(xué)分析要求,具有組間可比性。2.中醫(yī)主證積分比較：三組在治療3個療程后,差異有統(tǒng)計學(xué)意義(P0.05),組間兩兩比較差異無統(tǒng)計學(xué)意義(P0.05)；停藥3個療程后,差異有統(tǒng)計學(xué)意義(P0.05),通過兩兩對比,中藥組和對照組、西藥組和對照組之間差異有統(tǒng)計學(xué)意義(P0.05)。數(shù)據(jù)表明,三組皆可改善患者的月經(jīng)情況,觀察時間越長,中藥組效果越好。3.中醫(yī)次證積分比較：三組在治療3個療程后及停藥3個療程后,組間差異均有統(tǒng)計學(xué)意義(P0.05)。數(shù)據(jù)表明,中藥組在改善次要癥狀方面優(yōu)于西藥組和對照組,且效果穩(wěn)定。4.中醫(yī)證候總積分比較：三組在治療3個療程后及停藥3個療程后,差異有統(tǒng)計學(xué)意義(P0.05)；通過組間兩兩對比,中藥組和對照組、西藥組和對照組之間差異有統(tǒng)計學(xué)意義(P0.05)；三組在治療后與停藥后組內(nèi)比較,無統(tǒng)計學(xué)意義(P0.05)。數(shù)據(jù)表明,三組中醫(yī)癥狀均有改善,但治療后與停藥后組內(nèi)差異不明顯,若延長觀察時間,則中藥組在改善中醫(yī)證候方面療效更持久。5.子宮內(nèi)膜厚度比較：三組在治療3個療程后,中藥組和對照組、西藥組和對照組之間差異有統(tǒng)計學(xué)意義(P0.05)；停藥3個療程后,三組之間差異均有統(tǒng)計學(xué)意義(P0.05)；三組在治療后與停藥后組內(nèi)比較,西藥組與對照組組內(nèi)差異明顯(P0.05)。數(shù)據(jù)表明,三組皆可抑制子宮內(nèi)膜異常增厚,且中藥組效果最明顯,且療效持久。6.臨床療效比較：三組在治療3個療程及停藥3個療程后,差異有統(tǒng)計學(xué)意義(P0.05)。通過兩兩對比,中藥組和對照組、西藥組和對照組之間差異有統(tǒng)計學(xué)意義(P0.05)。數(shù)據(jù)表明,在目前觀察時間內(nèi),中藥組與西藥組效果相當(dāng),且皆優(yōu)于對照組。7.復(fù)發(fā)率比較：三組于治療3個療程內(nèi)均無復(fù)發(fā)；停藥3個療程內(nèi)共復(fù)發(fā)6例,總復(fù)發(fā)率為7.78%。其中西藥組復(fù)發(fā)1例,復(fù)發(fā)率為3.33%,對照組復(fù)發(fā)5例,復(fù)發(fā)率為16.67%。通過統(tǒng)計學(xué)分析,三組間的復(fù)發(fā)率有統(tǒng)計學(xué)意義(P0.05),但兩兩比較無明顯差異(P0.05)。結(jié)論：1-中藥定經(jīng)湯加味可顯著改善腎虛血瘀型子宮內(nèi)膜息肉患者宮腔鏡術(shù)后月經(jīng)情況及中醫(yī)證候。2.中藥定經(jīng)湯加味可明顯抑制子宮內(nèi)膜厚度,降低子宮內(nèi)膜息肉復(fù)發(fā)率。3.中藥定經(jīng)湯加味在治療腎虛血瘀型子宮內(nèi)膜息肉宮腔鏡術(shù)后患者時無明顯不良反應(yīng),值得在臨床上推廣使用。
[Abstract]:Objective: To evaluate the effect and clinical advantage of traditional Chinese medicine on the prevention and treatment of endometrial polyps by observing the effect of traditional Chinese medicine on menstruation, syndrome of TCM syndrome and recurrence of polyps after hysteroscopy of endometrial polyps with kidney deficiency and blood stasis. Methods: Ninety-four cases were randomly divided into 31 cases of Chinese medicine group, 32 cases of western medicine group and 31 cases of control group. The traditional Chinese medicine group started taking the traditional Chinese medicine at the 8th day of each menstrual cycle after the hysteroscope, and the traditional Chinese medicine is continuously taken for 14 days (the operation month, the operation is started after the operation), On the 16th day of each menstrual cycle after hysteroscopy, the western medicine group began to take the dydroxyprogesterone tablet (also taken periodically in the same month) for 10 days, each menstrual cycle was 1 course of treatment, and the control group was a simple group of surgery. By recording the patient's syndrome of TCM syndrome, the thickness of endometrium and the recurrence of endometrial polyps, the effects of menstruation regulating effect and clinical efficacy of the third menstrual cycle and the 6th menstrual cycle in each group were evaluated. Finally, the recorded data were analyzed statistically by SPSS 10.0 software package. Result: 1. Before hysteroscopy, the age of three groups, the integration of traditional Chinese medicine, the integral of secondary symptoms, the total score of symptoms, the distribution of disease and the thickness of endometrium were not significant (P0.05). After 3 courses of treatment, there was no significant difference between the two groups (P0.05), and the difference was statistically significant after 3 treatment courses (P0.05). There was significant difference between the western medicine group and the control group (P0.05). Data showed that three groups could improve the menstruation of the patients, the longer the observation time, the better the effect of the traditional Chinese medicine group. After 3 courses of treatment and 3 treatment courses, the difference between the groups was statistically significant (P0.05). The data show that the traditional Chinese medicine group is superior to the western medicine group and the control group in improving the secondary symptoms, and the effect is stable. There was a significant difference in the difference between the two groups (P <0.05) and the control group (P <0.05). There was no significant difference between the three groups after treatment and in the group after drug withdrawal (P0.05). The data showed that the symptoms of the three groups were improved, but the difference between the treatment group and the group after discontinuation was not obvious, and if the observation time was prolonged, the curative effect of the traditional Chinese medicine group on improving the syndrome of traditional Chinese medicine was more durable. Compared with the control group, the difference between the western medicine group and the control group was statistically significant (P0.05). There was no significant difference between the western medicine group and the control group (P0.05). The data showed that the abnormal thickening of endometrium was inhibited in three groups, and the effect of traditional Chinese medicine group was most obvious and the curative effect was durable. The difference was statistically significant after 3 courses of treatment and 3 treatment courses (P0.05). The difference between the two groups, the control group, the western medicine group and the control group was statistically significant (P0.05). The data showed that in the current observation time, the effect of the traditional Chinese medicine group and the western medicine group was comparable and better than that of the control group. The recurrence rate was compared: there was no recurrence within 3 courses of treatment, 6 cases were recurred in 3 courses of treatment, and the total recurrence rate was 7.78%. The recurrence rate was 3.33% in western medicine group, 5 in control group and 16.67% in control group. Statistical analysis showed that the recurrence rate among the three groups was statistically significant (P0.05), but there was no significant difference between the two groups (P0.05). Conclusion: 1-Chinese medicine can significantly improve the menstruation and TCM syndrome after hysteroscopy in patients with endometrial polyps with kidney deficiency and blood stasis. Traditional Chinese medicine can significantly inhibit the endometrial thickness and reduce the recurrence rate of endometrial polyps. The traditional Chinese medicine has no obvious adverse reaction in treating patients with renal deficiency and blood stasis type endometrial polyps after hysteroscopy, and is worthy of being popularized and used clinically.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R271.9

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