| Objective:Endometriosis is a common disease of the female reproductive system,manifested by persistent changes in pelvic adhesions,pain,and infertility.According to reports,infertility accounts for 30%-50% of endometriosis,and the incidence of endometriosis in women with infertility is 6-8 times higher than normal.In this study,laparoscopy combined with Bushen Tongmai Yin was used to treat endometriosis with insufficiency of kidney and blood stasis and infertility,with a view to providing broader clinical ideas for Chinese medicine to treat endometriosis with infertility.Methods:This study collected 94 patients with endometriosis and infertility treated in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2017 to May 2020.All patients underwent laparoscopic surgery,and the pathological diagnosis was confirmed to be intrauterine.Heterotopic syndrome,TCM syndrome differentiation is of kidney deficiency and blood stasis type.The random number table method divided 94 patients into a Chinese medicine group(n=32),a western medicine group(n=32),and a control group(n=30).After the operation,the Chinese medicine group was given Bushen Tongmai Decoction plus or minus treatment,the western medicine group was given goserelin acetate,and the control group was simply treated with laparoscopy.Compare general clinical data such as age,BMI,occupation,education background,stage of infertility,disease stage,etc.of the three groups of patients,TCM symptom score,improvement of dysmenorrhea,EFI score,fallopian tube function score,pregnancy rate,pregnancy loss,endometrium Thickness,uterine artery pulsation index,resistance index,endometrial artery pulsation index,resistance index,and changes in serum FSH,LH,PRL,MMP-9,and TIMP-1 levels were measured before and after treatment.Results:There was no significant difference in age,disease stage,BMI,infertility course,occupation,and education background among the three groups(P> 0.05).The Chinese medicine group is better than the western medicine group and the control group in improving the symptoms of traditional Chinese medicine(P <0.05),while the western medicine group is better than the control group in improving the symptoms of traditional Chinese medicine(P <0.05),and the differences are statistically significant(P <0.05).The Chinese medicine group was better than the western medicine group and the control group in improving dysmenorrhea(P <0.05),while the western medicine group was better than the control group in improving the symptoms of Chinese medicine,and the differences were statistically significant(P <0.05).There was no significant difference in EFI scores before treatment among the three groups of patients(P> 0.05).After treatment,the EFI scores of all three groups increased(P <0.05).The EFI score of the Chinese medicine group was higher than that of the western medicine group and the control group(P<0.05),the reproductive function score of the western medicine group was higher than that of the control group(P <0.05).There was no significant difference in tubal scores between the three groups of patients before treatment(P> 0.05);there was no significant difference in tubal function scores between the three groups after treatment(P> 0.05).The scores were not statistically significant(P> 0.05).The pregnancy rate of patients in the Chinese medicine group was 68.75%(22/32),the pregnancy rate in the western medicine group was 43.75%(14/32),and the pregnancy rate in the control group was 13.3%(4/30).The pregnancy rate in the Chinese medicine group was significantly higher than that in western medicine.Group and control group(P <0.05),the pregnancy rate of the western medicine group was higher than that of the control group(P <0.05).There was no significant difference in pregnancy loss among the three groups(P >0.05).There was no significant difference in the endometrial thickness between the three groups before treatment(P>0.05);there was no significant difference in the endometrial thickness between the three groups after treatment(P> 0.05).The endometrial thickness was not statistically significant(P> 0.05).Before treatment,there was no significant difference in PI between the three groups of uterine arterial blood flow(P> 0.05).After treatment,the PI of uterine arterial blood flow in the Chinese medicine group was lower than that in the western medicine group and the control group(P <0.05).The blood flow PI was lower than the control group(P<0.05).Before treatment,there was no significant difference in RI of uterine arterial blood flow between the three groups(P> 0.05).After treatment,the RI of uterine arterial blood flow in the Chinese medicine group was lower than that in the western medicine group and the control group(P <0.05).There was no significant difference in RI of uterine arterial blood flow in the group(P> 0.05).Before treatment,the endometrial blood flow PI of the three groups was not significantly different(P> 0.05).After treatment,the endometrial blood flow PI of the Chinese medicine group was lower than that of the western medicine group and the control group(P <0.05).Endometrial blood flow PI was lower than that in the control group(P <0.05).Before treatment,the endometrial blood flow RI of the three groups was not significantly different(P> 0.05).After treatment,the endometrial blood flow RI of the Chinese medicine group was lower than that of the western medicine group and the control group(P <0.05).Endometrial blood flow RI was lower than the control group(P <0.05).Before treatment,there was no significant difference in the levels of sex hormones FSH,LH,PRL in the three groups of patients(P> 0.05).There was no significant difference in FSH levels between the three groups of patients before and after treatment(P> 0.05).After treatment,the level of LH in the traditional Chinese medicine group was significantly increased,and the level of PRL was significantly reduced.Compared with the western medicine group and the control group,the differences were statistically significant(P<0.05).The LH level in the western medicine group was significantly increased,and the PRL level was significantly lower than that in the control group(P <0.05).There was no significant difference in serum MMP-9 and TIMP-1 between the three groups of patients before treatment(P> 0.05).After treatment,the expressions of MMP-9 and TIMP-1 in all three groups decreased(P <0.05);the decline in MMP-9 and TIMP-1 in the Chinese medicine group was better than that in the western medicine group and the control group(P <0.05);-9.The degree of TIMP-1 decline was better than that of the control group(P <0.05).Conclusion:Laparoscopic surgery + Bushen Tongmai Decoction has a significant effect on patients with endometriosis of kidney deficiency and blood stasis combined with infertility.It can improve the clinical symptoms of Chinese medicine,improve clinical symptoms,increase the chance of conception,and increase the capacity of the endometrium.Acceptable,and can regulate the secretion of estrogen in the body,and promote the balance of extravascular matrix,which has obvious advantages over western medicine treatment and surgery alone. |
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