中医内外合治法对输卵管阻塞性不孕症介入疗效的影响

目的:评价丹参注射液宫腔给药联合活血化瘀中药外敷、灌肠对输卵管阻塞性不孕症介入疗效的影响,探讨其临床意义。方法:91例输卵管阻塞性不孕症患者按照2∶1比例完全随机分为试验组和对照组。试验组采用输卵管再通术(fallopian tuberecanalization,FTR)联合中医内外合治。对照组采用FTR和常规西药治疗。术后随访1～2年,记录受孕情况或行子宫输卵管造影复查输卵管通畅情况。结果:试验组与对照组结果对比分别如下,输卵管术后通畅率82.02%、64.29%;闭塞率17.98%、35.71%;再闭塞率12.66%、31.58%;宫内妊娠15(27.78%)例、4(16.67%)例;输卵管妊娠1(1.85%)例、3(12.5%)例;术后半年仍保持通畅或通畅度有改善的输卵管共计68(76.40%)条、18(42.86%)条。两组输卵管通畅度比较有显著差异(Z=-3.186,P=0.001)。结论:丹参注射液宫腔给药联合活血化瘀中药外敷、灌肠可提高输卵管阻塞性不孕介入术后的疗效,降低输卵管再粘连率,为受孕提供可能。

Treatment for Fallopian Tube Obstruction after Fallopian Tuberecanalization with Combination of the Internal and External Therapies in Traditional Chinese Medicine

Objective: To assess the short-term clinical efficacy of the protocol of combination of the internal and external therapies in TCM treating oviduct blockage after fallopian tuberecanalization(FTR),prospectively and randomly.Evaluate its safety and effectiveness.Methods: 91 consectuive patients with infertility induced by oviduct blockage defined according to the inclusion and exclusion criteria were divided into two groups(experimental group and control group) by 2∶ 1 ratio from Apr.2009 to Nov.2010,randomly.All of the patients were received fallopian tube recanalization.The patients of experimental group were received the treatment of Chinese herbs by oral,enema and external application according to syndrome differentiation of TCM about one week per month in 3 months after fallopian tuberecanalization.Perfuse the drugs which are different in two groups into uterine cavity about two times per month in 2 months after operation.The drugs include Radix Salvia Miltiorrhiza and gentamycin,dexamethasone,α-chymotrypsin in experimental and control groups,respectively.Observe the clinical symptoms and record findings.The patients were regularly followed up for 2 years.The patient which is not perceived during follow-up will be tested on HSG.Results: There were fallopian patent rate of 82.02%,64.29%;oviduct obstructed rate of 17.98%,35.71%;re-adhesion rate of 12.66%,31.58%;intrauterine pregnant rate of 27.78%,16.67%;ectopic pregnant rate of 1.85%,12.5%;response rate of 76.40%,42.86% in experimental and control groups,respectively.The patent rate of oviduct in experimental group was higher than that of the control group,the obvious significance between two groups in statistic(P<0.01).Conclusion:The treatment of Chinese herbs by oral,enema,external application according to syndrome differentiation of TCM and perfusing Radix Salvia Miltiorrhiza into uterine cavity is quite effective for prevention of the tubal re-adhesion after FTR and can increase the probabilities of conception.