1、知柏地黄冲剂对腹腔镜下卵巢子宫内膜异位囊肿剥知柏地黄冲剂对腹腔镜下卵巢子宫内膜异位囊肿剥 摘要 目的 分析知柏地黄冲剂对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢功能的影响。 方法 选取卵巢子宫内膜异位囊肿腹腔镜下剥除术患者120例,随机分为观察组与对照组。两组患者均给予腹腔镜下卵巢子宫内膜异位囊肿剥除术。观察组患者术后给予知柏地黄冲剂口服,对照组患者给予等剂量温水口服,观察时间为3个月。分别于治疗前、后采用免疫化学发光法检测血清促卵泡雌激素(FSH)、促黄体生成素(LH)、雌二醇(E2),采用阴道超声与盆腔超声多普勒联合监测窦卵泡计数(AFC)、卵巢基质血流阻力指数(RI),采用中医症候量表评
2、分评估临床疗效。 结果 治疗后,对照组患者血清FSH、LH水平升高,E2水平下降,治疗前后比较差异有统计学意义(P0.05)。治疗后,观察组与对照组比较,AFC增加,RI降低,两组比较差异有统计学意义(P0.05)。观察组临床疗效优于对照组,治疗后组间比较差异有统计学意义(P0.05)。 结论 知柏地黄冲剂可以下调腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢功能低下反应,有效改善患者术后短暂性卵巢储备功能下降而引发的临床症状,从而提高临床疗效。 关键词 卵巢子宫内膜异位囊肿剥除术;腹腔镜;卵巢储备功能;中药 中图分类号 R713 文献标识码 A 文章编号 1673-9701(2016)20-001
3、8-04 Abstract Objective To analyze the influence of Zhibai Dihuang granule stripping on the ovarian reserve function after operation of ovarian endometriosis cyst with laparoscopic. Methods One hundred and twenty cases of patients with ovarian endometriosis cyst were diagnosed by laparoscopy and ran
4、domly divided into the observation group and control group. The patients in the two groups were given enucleation of ovarian endometriosis cyst resection with laparoscopic. The patients in the observation group were given Zhibai Dihuang granule, while the patients in the control group were given the
5、 same dose warm water. They were observed for three months. Respectively before and after treatment,immunochemistry luminescence method was used to detect serum follicle stimulating hormone(FSH),luteinizing hormone (LH),estradiol(E2) by transvaginal ultrasonography and with pelvic ultrasound Doppler
6、 monitoring combined with antral bubble count, ovarian stromal blood flow resistance index, The TCM Syndrome Scale was to assess the clinical efficacy between the two groups. Results After treatment, the serum FSH,LH levels of patients in the control group elevated,the E2 levels decreased,there were
7、 statistically significant differences between before and after treatment(P0.05). After treatment,the observation group was compared with the control group,the level of AFC increased,while RI decreased,the difference between the two groups was statistically significant(P0.05). The clinical efficacy
8、of the observation group was better than that of the control group,the difference between the two groups was statistically significant(P0.05),具有可比性,见表1。 1.2 治疗方法 两组患者均在腹腔镜下采用全身麻醉方式行卵巢子宫内膜异位囊肿剥除术,手术止血方式采用薇乔2-0可吸收缝合线缝合与双极电凝方式止血。观察组患者术后给予知柏地黄冲剂口服,对照组患者给予等剂量温水口服,观察时间为3个月。知柏地黄冲剂组方:熟地10 g、知母10 g、淮山药10 g、丹
9、皮12 g、黄柏10 g、山萸肉10 g、菟丝子10 g、泽泻10 g,水煎服300 mL/次,2次/d,治疗时间2周。 1.3 检测指标 分别于治疗前、后月经自然周期第2天晨空腹取外周静脉血,采用免疫化学发光法检测血清促卵泡雌激素(follicle stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2),试剂盒由德国罗氏公司提供,按照说明书操作进行。 1.4 超声检查 采用GE Logi彩色超声诊断仪,探头频率5.07.0 MHz。采用阴道超声与盆腔超声多普勒联合监测窦卵泡计数(antral foll
10、icle count,AFC)、卵巢基质血流阻力指数(resistance index,RI),超声诊断由两位主治医师独立完成,二者诊断一致性检验(Kappa=0.820)。 1.5 疗效评定 参考中药新药治疗月经不调的临床研究指导原则,采用中医症候量表评分评估临床疗效。中医症候评分参照文献5。临床疗效指数=(治疗前积分-治疗后积分)/治疗前积分100%。显效:主次症状消失,疗效指数70%;有效:主次症状明显减轻,疗效指数30%;无效:主次症状无好转,疗效指数30%。 1.6 统计学分析 采用SPSS 21.0统计软件包,正态分布计量资料采用(xs)表示,两组间及组内比较采用t检验,计数资料以
11、率(%)表示,两组比较采用2检验,P0.05表示差异有统计学意义。 2 结果 2.1 两组患者治疗前后卵巢功能血清学指标比较 治疗后,对照组患者血清FSH、LH水平升高,E2水平下降,治疗前后比较差异有统计学意义(P0.05)。见表2。 2.2 两组患者治疗前后超声指标比较 治疗后,观察组与对照组比较,AFC增加,RI降低,两组比较差异有统计学意义(P0.05)。见表3。 2.3 两组患者临床疗效比较 观察组临床疗效优于对照组,治疗后组间比较差异有统计学意义(P0.05)。见表4。 3 讨论 卵巢储备功能是指卵巢内存留卵泡的数量与质量高低,也即卵巢皮质区内可受精卵母细胞发育成熟能力,是反映女性生育状况指标之一。可募集卵泡数量减少,卵母细胞质量下降可导致生育能力下降以及绝经期提前,临床又称为卵巢储备功能下降。影响卵巢储备功能下降的因素既有年龄、肥胖、遗传等个体体质性因素,又有盆腔感染、卵巢肿瘤、放疗、化疗以及子宫内膜异位症等卵巢破坏性因素。子宫内膜异位症是指具有生长分泌功能的子宫内膜组织出现在子宫以外组织,并因月经周期内反复发生出血等原因引发临床出现不孕、月经异常、盆腔粘连、性交痛等一系列临床症状
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