| Objective:To evaluate the effect of Guifuyin, Danchiyin, and Qidanyin of promoting blood circulation to remove blood stasis and gonadotropin-releasing hormone analogs (GnRH-a) or gestrinone on relapse rate, pregnancy rate and pregnancy outcome of the patients with endometriosis within3years after conservative operation, and the clinical effect of Traditional Chinese medicine of promoting blood circulation to remove blood stasis in the treatment of recurrent endometriosis, and discuss the feasibility of TCM that prevent the recurrence of endometriosis after conservative operation and treat recurrent endometriosis.Methods:This study is a part of the Key Project of the National Eleventh-Five Year Research Rrogram of China "The clinical research and curative effect evaluation of the treatment of endometriosis with TCM"(Grant No:2006BAI04A17), that is multicentre, prospective and randomized. The complete clinical material of240patients with endometriosis after laparotomy or laparoscopic surgery that were conservative were collected by each subject center from April2008to February2010, who were diagnosed endometriosis in pathology, these patients were randomized into research group and control group, each group has120patients, their course were3or6months according to r-AFS score. The observation group take guifuyin, danchiyin and qidanyin respectively according to TCM syndrome differentiation, the control group take gonadotropin-releasing hormone analogs (GnRH-a) or gestrinone. To evaluate the relapse rate and the pregnancy rate of the two groups, both groups were followed up during and afer the course every3menstrual cycles (that were followed up every three months whose menstruation is irregular or amenerrheic); all patients were followed up by3years, and they have been in the follow-up period. We would track their pregnancy outcome if the patients are pregnant, the patients would be followed up if their disease recur, they would be treated as same as the observation group if they like to use TCM (their course were6months). And they would fill up point tables about dysmenorrhea. chronic pelvic pain, menstruation and untoward effect, they were followed up during6months afer the course every3menstrual cycles, we would evaluate the effect of TCM in the treatment of recurrent endometriosis.Results:This study takes192patients as objects of study that complete the course and were followed up during3years after operation; there are99patients in the observation group and93patients in the control group.1The difference of recurrence rate between the two groups during3years after surgery is not statistically significant difference (P>0.05); the patients of one year after operation of both two groups with high recurrence rate; the difference of recurrence rate of Ⅰ,Ⅱ period and Ⅲ,Ⅳ period of the observation group is not statistically significant difference (P>0.05), the difference of recurrence rate of Ⅰ,Ⅱ period and Ⅲ, Ⅳ period of the control group is statistically significant difference (P<0.05); recurrence is linked to diffent periods, having thick endometrium, the recurrence rate of Ⅰ,Ⅱ period is higher than Ⅲ,Ⅳ period (P<0.05); the recurrence rate of patients with thick endometrium is higher than those without thick endometrium (P<0.05), recurrence is not linked to modus operandi, having dysmenorrhea before operation or not, having lower abdominal pain before operation or not, and having chocolate cyst of one side before operation or both sides (P>0.05).2The difference of pregnancy rate between the two groups during3years after surgery is not statistically significant difference (P>0.05); the mean time of pregnancy after operation of the observation group is shorter than control group(P<0.05); the patients of3months after operation of the observation group with high pregnancy rate, the patients of6months after operation of the control group with high pregnancy rate; the pregnancy rate of the patients between25to29years old of the two groups is the highest, followed by30to34years old, the patients over40years old with no pregnancy; pregnancy is linked to modus operandi, the pregnancy rate after laparotomy is higher than after laparoscopic surgery (P<0.05); pregnancy is not linked to different periods, having chocolate cyst of one side before operation or both sides (P>0.05);The difference of live birth rate and embryonic development stop rate of the two groups is not statistically significant difference (P>0.05).3There are38patients recurred during3years after operation,9patients of them were out followed up(23.7%),10patients of them choose to be treated with TCM(26.3%),4patients of them choose operation again(10.5%),15patients of them without treatment (39.5%). TCM can alleviate dysmenorrheal, chronic pelvic pain and improve menstruation (P<0.05), without untoward effect.Conclusion:The effect of traditional Chinese medicine of promoting blood circulation to remove blood stasis on preventing recurrence is sure. Recurrence is linked to diffent periods, having thick endometrium, not linked to modus operandi, having dysmenorrhea before operation or not, having lower abdominal pain before operation or not, and having chocolate cyst of one side before operation or both sides. The difference of pregnancy rate of the two groups is not statistically significant difference (P>0.05). The TCM has advantage in shortening the time of pregnancy after operation. Pregnancy is linked to modus operandi, not linked to different periods, having chocolate cyst of one side before operation or both sides. There are38patients recurred during3years after operation. The treatment after relapse is linked to desire, age, whether have fertility requirements, the severity of the disease. The effect of traditional Chinese medicine in the treatment of recurrent endometriosis is sure; TCM can alleviate dysmenorrheal, chronic pelvic pain and improve menstruation, without untoward effect. |
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