首页|补肾活血法联合腹腔镜治疗反复种植失败合并子宫内膜异位症临床观察

补肾活血法联合腹腔镜治疗反复种植失败合并子宫内膜异位症临床观察

扫码查看
目的 观察补肾活血法联合腹腔镜治疗反复种植失败(RIF)合并子宫内膜异位症(EMs)的临床疗效.方法 将72 例RIF合并EMs患者按照随机数字表法分为2 组,对照组 36 例予腹腔镜治疗,治疗组 36 例在对照组治疗基础上联合补肾活血法治疗.比较2 组子宫内膜异位症分期(r-AFS分期);比较2 组中医证候积分;比较2 组中医疗效;比较2 组内膜转化日子宫内膜厚度;比较2 组胚胎移植后血清人绒毛膜促性腺激素(β-hCG);比较2 组妊娠结局;比较2 组治疗前后实验室指标变化.结果 2 组年龄、体质量指数(BMI)、不孕病程、不良妊娠次数、移植失败次数比较差异均无统计学意义(P>0.05),具有可比性.2 组r-AFS分期比较差异无统计学意义(P>0.05).2 组治疗后中医证候积分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05).治疗组总有效率 75.0%(27/36),对照组总有效率50.0%(17/34),治疗组中医疗效优于对照组(P<0.05).治疗组内膜转化日子宫内膜厚度高于对照组(P<0.05).2 组血清β-hCG比较差异有统计学意义(P<0.05).治疗组胚胎种植率、临床妊娠率、持续妊娠率方面均优于对照组,且早期流产率低于对照组,但比较差异无统计学意义(P>0.05).2 组治疗后NK细胞比例均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05).2 组治疗后TNF-α均较本组治疗前降低(P<0.05),但组间比较差异无统计学意义(P>0.05).治疗后治疗组IL-6 较本组治疗前降低(P<0.05).结论 补肾活血法联合腹腔镜治疗RIF合并EMs,能有效改善患者中医证候积分和子宫内膜厚度,减少NK细胞比例,降低TNF-α、IL-6 水平,但对IL-10无明显影响.单纯腹腔镜治疗及中药联合腹腔镜治疗均能一定程度上提高胚胎种植率、临床妊娠率、持续妊娠率,其中中药联合腹腔镜治疗更有优势且流产率更低.
Clinical effect of kidney-nourishing and blood-activating therapy combined with laparoscopy for repeated implant failure and endometriosis
Objective To observe the clinical effect of kidney-nourishing and blood-activating therapy combined with laparoscopy for repeated implant failure(RIF)and endometriosis(EMs).Methods A total of 72 RIF patients with EMs were randomly assigned into treatment group(n=36)and control group(n=36).All patients were managed by laparoscopy,and those in treatment group were additionally treated with kidney-nourishing and blood-activating therapy.The aim was to com-pare revised American Fertility Society(r-AFS)stages,traditional Chinese medicine(TCM)syndrome score,TCM curative effect,endometrial thickness on the day of endometrial transformation,serum beta human chorionic gonadotropin(β-hCG)af-ter embryo transfer,pregnancy outcome,as well as laboratory indexes.Results The age,body mass index(BMI),course for infertility or infertility,times of adverse pregnancy or transplantation failure were comparable between the two groups(P>0.05).There was no statistically significant difference in r-AFS stages between the two groups(P>0.05).After treatment,TCM symptom scores in the both groups were significantly de-creased(P<0.05),which decreased notably in the treatment group compared with the control group(P<0.05).The overall effective rate in the treatment group was better than that in the con-trol group(75.0%[27/36]vs 50.0%[17/34],P<0.05).The endometrial thickness was significantly higher in the treatment group than in the control group(P<0.05).The difference was statistically significant in β-hCG between groups(P<0.05).The implantation rate,clinical pregnancy rate,and ongoing pregnancy rate in the treatment group were better than those of the control group(P<0.05).The early abortion rate was slightly lower than that of the control group(P>0.05).After treatment,the percentage of natural killer(NK)cell in the both groups was significantly decreased(P<0.05),the decrease in the treatment group was more common than the control group(P<0.05).The levle of tumour necrosis factor alpha(TNF-α)in the both groups were significantly decreased than before treatment(P<0.05),but there was no significant statistical difference in TNF-α between groups(P>0.05).After treatment,interleu-kin 6(IL-6)in the treatment group was significantly lower than before treatment(P<0.05).Conclusio The kidney-nour-ishing and blood-activating therapy combined with laparoscopy in RIF patients with EMs can effectively improve TCM syndrome scores and endometrial thickness,reduce NK cell percentage,and reduce the levels of TNF-α and IL-6,but it has no signifi-cant effect on IL-10.Combined treatment is superior to laparoscopy alone for the rates of implantation,clinical pregnancy,and ongoing pregnancy,and it has a lower abortion rate.

EndometriosisImplantIntegrated traditional Chinese and Western medicine therapy

谢一静、李瑄、苏嘉文、卜亚丽、彭绍婵、叶敦敏

展开 >

广州中医药大学第三附属医院妇二科,广东 广州 510375

子宫内膜异位症 种植 中西医结合疗法

2023年度广东省中医药局中医药科研项目2022年广州中医药大学第三附属医院科研创新基金课题广州中医药大学第三附属医院"瞪羚计划"

20233024Sy2022009中医三院发[2023]4号

2024

河北中医
河北省医学情报研究所,河北省中医药学会

河北中医

CSTPCD
影响因子:0.951
ISSN:1002-2619
年,卷(期):2024.46(6)