| Objective:To study the effect of TCM of promoting blood circulation and removing blood stasis combined with progesterone on preventing postoperative recurrence of endometrial polyps.To observe the expression of VEGF,CD38,CD 13 8,TCM syndromes,endometrial thickness and recurrence rate of the two groups by comparing with oral administration of progesterone(Dydrogesterone)alone.To explore the pathogenesis of endometrial polyps,and the mechanism of action of TCM of promoting blood circulation and removing blood stasis on endometrial polyps,and provide basis,ideas and methods for better prevention of recurrence of endometrial polyps in clinic with the help of integrated TCM and western medicine.Methods:60 patients who were diagnosed as "endometrial polyps" and met the inclusion criteria in the gynecological clinic of Jiangsu Provincial Hospital of TCM from January 2020 to January 2021 were included.The patients were divided into experimental group(30 cases)and control group(30 cases)according to the principle of randomized control.All 60 patients were treated by hysteroscopic endometrial polypectomy.Experimental group:Three months before operation,oral administration of TCM was given from D14 of menstrual cycle every month,once in the morning and once in the evening for 10 days.Oral administration of TCM and 1 tablet of Dydrogesterone(bid)was given on the 14th day after operation and the D14 of 2nd menstrual cycle after operation.Control group:No treatment was given before operation,1 tablet of Dydrogesterone(bid)was given on the 14th day after operation and the D14 of 2nd menstrual cycle after operation.Two groups of patients stopped taking medicine during menstruation and took contraceptive measures during medication.The expressions of VEGF,CD38 and CD 138 in endometrium,menstruation,TCM symptoms,endometrial thickness,uterine artery blood flow index and recurrence rate before and after treatment were compared and analyzed statistically.Results:2 cases in the experimental group and 1 case in the control group fell off.Finally,28 cases in the experimental group and 29 cases in the control group were included.Before treatment,there was no significant difference in age,operation time,intraoperative blood loss and TCM syndromes between the two groups(P>0.05),and the data were comparable.The expression of VEGF in the experimental group was significantly lower than that in the control group(P<0.05).There was no significant difference in the expression of CD38 and CD138(P>0.05),indicating that TCM could reduce the expression of VEGF,but could not reduce the expression of CD38 and CD 138.There was no correlation between the expression of VEGF and the expression of CD38,CD138,but a positive correlation between the expression of CD38 and CD 138.Comparison of curative effects at 6 months after operation:(1)Menstruation:The total effective rate of the experimental group was higher than that of the control group,which showed that the experimental group improved menstruation better than the control group.The experimental group was better in the treatment of prolonged menstruation,menstrual volume,abdominal pain and irregular vaginal bleeding,the difference was significant(P<0.05).(2)TCM syndrome score:there was a significant difference between the two groups before and after treatment(P<0.05),indicating that both groups had curative effect in improving TCM syndrome.After treatment,the score of the experimental group was significantly lower than that of the control group,and the effective rate was 92.9%in the experimental group and 79.3%in the control group,indicating that the effect of the experimental group was better(P<0.05).(3)Endometrium thickness:There were significant differences between the experimental group and the control group before and after treatment(P<0.05),indicating that both groups could reduce the thickness of endometrium.There was significant difference between the two groups after operation(P<0.05),indicating that the experimental group was better in reducing the thickness of the endometrium than tha of the control group.(4)Uterine artery blood flow index(PI,RI):after treatment,PI,RI values of the two groups were significantly higher than before treatment(all P<0.05),indicating that both groups could increase the PI and RI values of uterine artery.The comparison between groups showed that the PI and RI values of the experimental group were significantly higher than those of the control group,indicating that the effect of the experimental group in changing the uterine artery blood flow index was better than that of the control group.(5)Recurrence of endometrial polyps:the recurrence rate of the experimental group was 3.6%,and the recurrence rate of the control group was 27.6%.The difference was statistically significant,indicating that the TCM of promoting blood circulation and removing blood stasis combined with progesterone had better clinical benefits in preventing the recurrence of endometrial polyps.Results:2 cases in the test group fell off,and 1 case in the control group fell off.Before treatment,the two groups of patients were compared in terms of age,operation time,intraoperative blood loss,TCM syndromes,etc.There was no significant difference(P>0.05),and they were comparable.The expression of VEGF in the endometrium of the experimental group was significantly lower than that of the control group(P<0.05).There was no significant difference in the expression of CD38 and CD 138(P>0.05),indicating that traditional Chinese medicine can reduce the expression of VEGF,but not the expression of CD38 and CD 13 8.The expression of VEGF has no correlation with the expression of CD38 and CD138,and the expression of CD38 and CD 138 is positively correlated.Comparison of curative effects at 6 months after operation:(1)Menstruation:The total effective rate of the test group is higher than that of the control group.It can be seen that the improvement of menstruation in the test group is better than the control group.In the treatment of prolonged menstrual period,heavy menstrual volume,abdominal pain during menstruation and irregular vaginal bleeding,the difference was significant(P<0.05),and the test group was better.(2)TCM Syndrome Score:The difference between the two groups before and after treatment is significant(P<0.05).It can be seen that the two groups have curative effects in improving patients’ TCM syndromes.The score of the test group after treatment was significantly lower than that of the control group,and in terms of effective rate comparison,the test group was 92.9%and the control group was only 79.3%,indicating that the test group had better results(P<0.05).(3)Endometrial thickness:The test group and the control group are significantly different before and after treatment(P<0.05),indicating that both groups can reduce the thickness of the endometrium.However,the difference between the groups was significant(P<0.05),and the experimental group was able to reduce the thickness of the endometrium better than the control group.(4)Uterine artery blood flow index(PI,RI):After treatment,the PI and RI values of the two groups were significantly higher than before treatment(both P<0.05).It can be seen that both groups can increase the uterine artery PI and RI values..In comparison between the groups,the PI and RI values of the experimental group were significantly higher than those of the control group,indicating that the experimental group was better than the control group in changing the uterine artery blood flow index.(5)Recurrence of endometrial polyps:the recurrence rate of the experimental group was 3.6%,and the recurrence rate of the control group was 27.6%.The difference was statistically significant,indicating that the Chinese medicine for promoting blood circulation and removing blood stasis combined with dydrogesterone has better clinical benefits in preventing the recurrence of endometrial polyps Great.Conclusion:1.TCM of promoting blood circulation and removing blood stasis can reduce the expression of VEGF in endometrium.The combination of TCM and Dydrogesterone in treating patients with endometrial polyps after operation can obviously improve menstruation,TCM syndrome,reduce endometrial thickness and recurrence rate.The clinical benefits of integrated TCM and western medicine treatment are better than those of western medicine treatment alone.2.The occurrence of EP may be related to the hyperproliferation of blood vessels and the stimulation of chronic endometritis,but the correlation between the two has not been found yet. |
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