左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的临床疗效。方法:52例子宫腺肌病患者于月经期的第5~7天放置LNG-IUS,观察术前、术后1个月、3个月、6个月及1年后痛经程度、月经量及子宫大小的变化。结果:放置LNG-IUS后3个月,月经量显著减少,降低为治疗前的(28±5)%,治疗前后比较差异有统计学意义(P<0.01);28例贫血患者血红蛋白含量显著增加,由治疗前的(85±24)g/L恢复至(118±7)g/L;子宫大小均较前缩小,由治疗前的(17.8±1.8)cm减小为(17.5±1.6)cm,但差异无统计学意义(P>0.01);放置LNG-IUS后12个月,52例患者中49例患者痛经完全消失,3例患者痛经评级降低≥2个级别,但疼痛未完全消失。结论:LNG-IUS治疗子宫腺肌病近期疗效显著。     

The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis

Background

The objective of this study was to evaluate the efficacy and side effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of moderate or severe dysmenorrhea associated with adenomyosis for a 3-year follow-up period.

Study Design

The LNG-IUS was inserted into 94 women who had moderate or severe dysmenorrhea associated with adenomyosis diagnosed by transvaginal sonography during Cycle Days 5-7. A visual analogue scale (VAS) of dysmenorrhea, uterine volume and serum CA125 levels were used to assess the efficacy of the treatment at baseline and 3, 6, 12, 24 and 36 months after the LNG-IUS insertion. Side effects were recorded at every follow-up visit.

Results

The VAS of dysmenorrhea dropped continuously and significantly from the baseline score of 77.9±14.7 to 11.8±17.9 after 36 months of the LNG-IUS insertion (p<.001). The uterine volume decreased significantly from 113.8±46.9 mL to 94.5±40.1 mL (p=.003) at 6 months and to 87.7±35.8 mL (p<.001) at 12 months and then rose slightly, but the variables at 24 and 36 months still decreased significantly in comparison with the baseline variable (p<.001). The serum CA125 levels reduced significantly starting from 6 months after device insertion (p<.001). The most common side effects were weight gain (28.7%), simple ovarian cyst formation (22.3%) and lower abdominal pain (12.8%). At 36 months, the overall satisfaction rate of the treatment was 72.5%.

Conclusions

The LNG-IUS appears to be an effective method in alleviating dysmenorrhea associated with adenomyosis during 3 years. It may be a valuable long-term alternative for the treatment of adenomyosis.     

王庆国治疗痛经病经验撷菁

王庆国教授临床善用经方,灵活施治妇科经带胎产诸病。王师治疗痛经,依据"痛则不通"的理论,强调着眼于"不通"这一主要矛盾,力主"通则不痛"。分论气滞寒凝两大证型。气滞血瘀证,主以《本事方》琥珀散;寒凝血瘀证,方用少腹逐瘀汤、温经汤等,临床疗效突出。     

加味没竭汤治疗原发性痛经的临床研究—对前列腺素及相关因素的影响

用加味没竭汤治疗原发性痛经６３例，并与消炎痛治疗者３２例作为对照。经３个月治疗，加味没竭汤组近期治愈率４１．３％，消炎痛组为１５．６％，两组间差异显著（Ｐ＜０．０５）。加味没竭汤可明显降低经血中ＰＧＦ２α、ＰＧＥ２的含量及比值，显著降低外周血黄体中期Ｅ２的含量，显著升高黄体末期孕酮含量。分析３３例经血ＰＧＦ２α，ＰＧＥ２含量与疼痛程度呈正相关。     

青少年痛经及相关因素分析

目的:调查痛经及其相关因素对青少年的影响,以便有效开展青春期保健教育。方法:采取整群抽样方法对江门市区以及乡镇中学部和大专院校女生进行问卷调查,对有效样本782份采用SPS10.0数据统计分析。结果:痛经发生率为54.2%,初潮年龄、月经周期、经期暴饮暴食及抽烟喝酒与痛经无直接关系,P值>0.05。月经期参加不适宜运动、经期冷水淋浴、经期不良情绪、吃生冷食物与痛经有直接关系。经χ2检验,P值依次为χ2=13.350,P<0.001,χ2=4.054,P<0.05,χ2=28.935,P<0.001,χ2=4.356,P<0.005。结论:应加强青少年重视月经生理的宣传教育,消除她们的恐惧、焦虑及精神负担,加强经期卫生,避免剧烈运动、过度劳累和防止受寒,做好经期卫生保健,是预防妇女疾病的重要环节之一,有利于青少年健康成长。     

OTR、ER在子宫腺肌病中的表达及与痛经的关系

目的:探讨OTR、ER在子宫腺肌病患者在位及病灶组织中的表达及其与痛经的关系。方法:采用免疫组化法检测30例子宫腺肌病在位和异位内膜中OTR、ER的表达,以子宫正常肌层组织和在位内膜为对照。结果:在子宫腺肌病灶组织中OTR、ER的表达高于在位内膜组及对照组(P<0.05);在子宫腺肌病组的在位内膜和病灶组织中,痛经组OTR、ER的表达高于无痛经组及对照组(P<0.05);在不同痛经程度分组中OTR、ER的表达依次降低。在子宫腺肌病的在位内膜和病灶组织中,OTR、ER两者之间存在正相关关系。结论:子宫腺肌病组织中OTR、ER的表达随痛经程度增强而增加,在子宫腺肌病痛经的发生与发展间可能存在协同作用。     

厦门市某中学2050名女生月经状况调查

目的：了解厦门市女中学生月经状况,为青少年经期保健和防止月经病提供依据.方法：采用自编调查问卷,对厦门某中学全体女生进行现场匿名调查.结果：月经初潮平均年龄为（12.86±0.75） 岁,痛经、经前期紧张综合征、月经不调总患病率分别为65.5%、56.4%、27.5%.痛经、经前期紧张综合征患病率和严重程度随年级的升高呈递增趋势,月经不调患病率随年级的升高呈递减趋势.结论：女中学生存在不同程度的月经健康问题和隐患,应针对她们的现况开展相关的经期保健服务.     

浮针配合中药热敷治疗原发性痛经疗效观察

目的观察浮针配合中药热敷治疗原发性痛经的临床疗效,并探讨其治疗机制。方法将符合纳入标准的130例原发性痛经患者随机分为治疗组70例和对照组60例,治疗组采用浮针配合中药热敷治疗,对照组口服布洛芬缓释胶囊治疗。治疗3个月经周期后比较两组临床疗效,并观察两组治疗后6个月痊愈患者复发率。结果治疗组痊愈率和总有效率分别为62.8%和95.7%,对照组分别为40.0%和81.7%,两组痊愈率和总有效率比较,差异均具有统计学意义(P0.05)。治疗组痊愈患者治疗后6个月复发率为15.9%,对照组为37.5%,两组比较差异具有统计学意义(P0.05)。结论浮针配合中药热敷是一种治疗原发性痛经的有效方法。     

针灸治疗原发性痛经的临床疗效及对血液流变学的影响

目的探讨针灸治疗原发性痛经的临床疗效及对血液流变学的影响。方法选择我院2014年4月—2016年3月收治的76例原发性痛经患者为研究对象,以随机数字表法分组,观察组与对照组各38例,对照组单用药物治疗,观察组在药物基础上加针灸治疗,对两组患者疗效与血液流变学水平进行观察。结果观察组与对照组治疗总有效率分别为89.47%、65.79%,两组差异有统计学意义(P0.05);两组患者治疗前的全血黏度、血浆黏度、红细胞压积等血液流变学参数无明显差异(P0.05),治疗后均有改善,且观察组血液流变学参数均低于对照组,差异有统计学意义(P0.05)。结论针灸应用于原发性痛经治疗中效果满意,可有效调节血液流变学,对缓解临床症状具有显著作用,值得临床推广。     

Clinical Application of Moxibustion on Guanyuan （CV 4）

Guanyuan （CV 4） is located 3 cun below the umbilicus, on the midline of abdomen. It is the Front-Mu Point of the Small Intestine, a crossing point of Three Yin Meridians of Foot and Conception Vessel. It can warm the kidney to invigorate yang, tonify the Yuan-Primordial qi, dredge and regulate Thoroughfare and Conception Vessels,