输卵管性不孕的中西医临床研究进展

【作者】 王春芳；

【导师】 陆华；

【作者基本信息】 成都中医药大学 ， 中医妇科学， 2005， 硕士

【摘要】 目的:综述中西医治疗输卵管性不孕的临床研究进展,观察接绪疗法治疗输卵管性不孕的临床疗效。 方法:从输卵管性不孕的危险因素、病理、西医诊治、中医药治疗、综合治疗进行综述。对符合纳入标准的输卵管性不孕症患者13例,运用接绪疗法,即中药辨证内治、妇乐颗粒灌肠配合恒频磁共振理疗,3个月为1疗程,治疗1～3个疗程后行输卵管碘油造影复查,观察接绪疗法对输卵管通畅度、形态走向的影响。 结果:根据近十年来的121篇文献报道,输卵管性不孕约占女性不孕患者的20%～40%,西医多采用手术、介入疗法、体外受精及胚胎移植(IVF-ET)等方法治疗。腹腔镜手术和显微外科手术的妊娠率为31.58%-76.16%,但异位妊娠率达7.69%-25.0%。输卵管介入技术,提高了再通率(76%-95.77%),但术后再粘连率为5.88%-28%、异位妊娠率为10.0%-11.2%,宫内妊娠率为30.9%-50%,对远端阻塞者效果差。IVF-ET技术每个移植的胚胎仅有10%～20%的着床率,多胎妊娠率达20%～30%。中药多途径给药配合输卵管通液术、理疗或介入治疗等综合疗法是目前常用的治疗方法,输卵管复通率为50%-96.6%,妊娠率为34.6%-81.4%。 临床运用接绪疗法治疗输卵管性不孕13例,妊娠3例,显效4例,有效4例,无效2例,愈显率53.8%,总有效率84.6%,与疗前比较,症状、体征评分明显下降(P<0.05)。 结论: 1、手术、介入疗法、IVF-ET为治疗输卵管性不孕的有效方法,但存在术后再粘连、异位妊娠、费用昂贵的问题,宫内妊娠率尚不理想。 2、中医综合疗法是治疗输卵管性不孕的发展趋势,但存在方法操作烦琐、疗程长的问题,疗效判定标准尚待统一,疗效仍待提高。 3、临床观察初步提示,接绪疗法是治疗输卵管性不孕的有效方法,值得进一步研究。更多还原

【Abstract】 Objective: To summarize the progression of clinical research on tubal infertility by treatment of traditional Chinese medicine(TCM) and westen medicine.And to observe the curative effect of JIEXU therapy on tubal infertility.Method: First summarize the pathology,risky factors,treatmcnt of westen medicine,TCM treatment,combined therapy of tubal infertility.Then to abserve the effect of connection therapy on the smooth,conformation and shape of uterine tube by treating 13 patients in clinic who all suffer from tubal infertility and accord with diagnostic standard of tubal infertility with connection therapy.Connection therapy is a integrated method in clinic doctor treat patient by TCM endotherapy ,coloclysis with FuLe granule and constant frequent magnetic resonance,a kind of physical therapy.After 1~3 period of treatment(3 months is equal to 1 period),the iodipin opacification of uterine tube was rechecked. Result: Accoring to the report of about 121 literatures during decade,it is said that 20~ 40 percent patients among the whole patients who get infertility is suffering from tubal infertility.The operation,intervention and in vitro fertilization and embryo transfer(IVF-ET) are appled by Westen medicine doctor.The pregnancy rate after the treatment of celoscope and microsurgery is 31.58%-76.16%.But there is a high ectopic pregnancy rate which is about 10.0%-11.2%.Though the intervention could improve the recanalization rate to 76%-95.77%,the rate of readhesion rate,ectopic pregnancy rate and intrauterine gestation is 5.88%-28%,10.0%-11.2% and 30.9%-50% respectively.The intervention has a short effect for the patients whose distal segment of uterine tube is blocked.After IVF-ET treatment,nidation rate of each transplanted embryo is only 10%~20%,and Multiple pregnancy rate is 20%~30%. Now the combined therpy which in clinic doctors apply by means of external use and oral taken of TCM ,hydrotubation,physical therapy and intervention.After this theropy the rate of uterine tube which is unobstructed is 50%-96.6%,and the pregnancy rant is 34.6%-81.4%.Based on the data of this clinical observation,3patients are pregnant again,4 cases are excellence,4 cases are effective and 2更多还原