| Objective:To comparison and analysis of the clinical curative effect of TCM staging combined therapy of removing stasis and resolving phlegm and invigorating kidney in the treatment of different types of endometriosis infertility patients, for example peritoneal, ovarian, depth invasion and ovarian combined peritoneal type, of kidney deficiency and phlegm stasis syndrome after laparoscopic operation.Methods:In accordance with the inclusion criteria choose endometriosis infertility (kidney deficiency phlegm and blood stasis syndrome) patients as the research object, and check the serum CA125 value and perform TCM syndrome score of each patient before treatment. Then all the research subjects were divided into 4 groups, the peritoneal group(the peritoneal type), the ovary group (the ovary type), the invasive group (the deep invasive type), the mixed group (the ovarian and peritoneal type) according to the clinical pathological types of the patients under laparoscopy. Then each group began to receive TCM staging combined therapy of removing stasis and resolving phlegm and invigorating kidney. The TCM staging combined therapy included two stages:treatment period and trial pregnancy period. In the treatment period, the primary goal was to eliminate pathogenic factors, through oral "XiaoZheng Heji" and "Fuke GuanChang Ye"retention enema to achieve the purpose of removing stasis and phlegm. In trial pregnancy period, it was to strengthen the body resistance, through oral "Zhuyun Koufu Ye" to achieve the purpose of nourishing kidney essence and helping to be pregnant, but it was still with removing stasis and phlegm when nearing ovulation. Finally, compare and analyze the TCM syndrome score, serum CA125 value, pregnancy rate and clinical efficacy of each group.Results:1 General situation:1.1 There were 153 cases of patients who were being followed up for 1 years, but 9 cases were lost,4 cases were excluded because of poor compliance. Finally,140 cases were followed up, including 73 cases of peritoneal group (52.14%),28 cases of ovarian group (20%),10 cases of depth invasion group (7.14%), and 29 cases of mixed group (20.71%).1.2 There was no significant difference in age, type of infertility, and age of infertility in the four groups (P>0.05).1.3 Endometriosis stage of the 4 groups of patients was respectively:peritoneal group:I stage (60.27%), II stage (39.73%), ovarian group:I stage (3.57%), II stage (14.29%), III stage (67.86%), IV stage (14.29%), depth invasion group:III stage (40%), IV stage (60%), mixed group:I stage (48.28%), II stage (3.45%), III stage (41.38%), IV stage (6.90%), and the 4 groups of patients with endometriosis stage comparison, the differences were statistically significant (P<0.05).2 TCM syndrome score:2.1 The TCM syndrome score of the 4 groups before treatment were:peritoneal group (11.18±2.23), ovarian group (16.57±2.82), depth invasion group (20±2.31), mixed group (17.03±3.80); and the difference was statistically significant (P<0.001).2.2 There were significant differences in the scores of TCM syndromes of each group in the 4 group before and after treatment (P<0.001).2.3 There were significant differences in the scores of TCM syndromes between the four group before and after treatment (P<0.001), and then two two of them about before and after treatment, there were no significant differences in ovarian and mixed groups (P=0.717, P =0.538, P=0.717), and the other two groups were statistically significant (P<0.05).3 CA125 value:3.1 The CA125 value of the 4 groups before treatment were:peritoneal group (17.55±7.93U/mL), ovarian group (34.56±15.80U/mL), infiltration group (38.01±6.87U/mL), mixed group (30.08±12.17U/mL). There were significant differences in CA125 values between the 4 groups before treatment (P<0.01). Of these two two comparisons, there was no significant difference before treatment among the ovarian, infiltration and mixed group (P=0.159, P=0.334, P=0.052).3.2 The CA125 value of the 4 groups before and after treatment:There were significant differences among the Peritoneal, ovarian and mixed groups (P<0.01). In deep infiltration group, the difference of CA125 value was not significant (P>0.05) between before treatment and after 3 months of surgery. But before treatment and after 6 months of surgery, after 3 months of surgery and after 6 months of surgery, the difference all was statistically significant (P<0.01).3.3 The difference between the 4 groups of CA125 value before and after treatment was statistically significant (P<0.01). After 3 months of surgery and after 6 months of surgery, the CA125 values of each two groups were compared between the 4 groups, the difference was statistically significant (P<0.05), except for the ovarian group and mixed groups (P=0.962, P=0.109).4 pregnancy rate:4.1 The total pregnancy rate of the 4 groups after 3 months of surgery was 8.57% (12/140), the peritoneal group was 12.33%(9/73), ovarian group was 3.57%(1/28), infiltration group was 0.00%(0/10), mixed group was 6.90%(2/29), and the difference of the 4 groups of pregnancy rate was not statistically significant (P>0.05).4.2 The total pregnancy rate of the 4 groups after 6 months of surgery was 23.57% (33/140), the peritoneal group was 28.77%(21/73), ovarian group was 17.86%(5/28), infiltration group was 10%(1/10), mixed group was 20.69%(6/29), and the difference of the 4 groups of pregnancy rate was not statistically significant (P>0.05).4.3 The total pregnancy rate of the 4 groups after surgery of 12 months was 46.43%(65/140), the peritoneal group was 61.64%(45/73), ovarian group was 32.14%(9/28), infiltration group was 10%(1/10), mixed group was 34.48%(10/29). There were no significant differences in the two two groups between the three groups, the ovarian group, depth invasion group and mixed group (P=0.236, P=0.851, P=0.228), but the difference in the other two two groups was statistically significant (P<0.01).5 clinical curative effect:The clinical total effective rate was respectively:91.78%(67/73) of peritoneal group, 75%(21/28) of ovarian group,60%(6/10) of infiltration group,72.41%(21/29) of mixed group. There were no significant differences in the two two groups between the three groups, the ovarian group, depth invasion group and mixed group (P=0.432, P=0.%25, P=0.693), but the difference in the other two two groups was statistically significant (P<0.05).Conclusion:1 For different clinical and pathological types of endometriosis infertility, the TCM syndrome score and endometriosis r-AFS stage have certain differences.2 The use of TCM staging combined therapy of removing stasis and resolving phlegm and invigorating kidney can improve the TCM syndrome score of different clinical and pathological types of endometriosis of kidney deficiency and phlegm stasis syndrome, reduce the level of serum CA125 in patients with different types of endometriosis infertility, as peritoneal, ovarian, depth infiltration and mixed types.3 But in a short period of time, the level of serum CA125 of infiltration type of endometriosis infertility was not significantly improved, there was be a result after surgery for 6 months.4 This kind of comprehensive therapy can well improve the peritoneal endometriosis infertility pregnancy rate and clinical efficacy. |
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