| Objective: To explore the clinical efficacy of Modified Qingretiaoxue decoction combined with dydrogesterone in the prevention and treatment of postoperative recurrence of endometrial polyps with damp-heat stasis,and to discuss a preliminary analysis of the mechanism of TCM in preventing recurrence,in order to obtain a good clinical curative effect and patient.Methods: From January 2021-June 2022,65 patients were admitted to the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were hospitalized with "uterine space occupation or abnormal uterine bleeding" and confirmed as endometrial polyps and consistent with TCM syndrome of damp-heat stasis after hysteroscopy by pathological results.65 patients were divided into 32 cases in the control group and 33 cases of treatment group according to the spss statistical analysis software randomly.According to the pathological results,the endometrium in the control group showed changes in proliferative stage began to take dydrogesterone on the 16 th day after surgery.If the endometrium was secretory phase change,started to take dydrogesterone on the day of pathological findings.Usage: 10 mg po bid x 10 days,then at the 16 th day of the next menstrual cycle in the same way to took dydrogesterone 10 days.Treatment group was given dydrogesterone in the same way.At the same time,Chinese medicine ×10 days was added on the second day after the postoperative vaginal bleeding was clear,took it twice one day,and was taken in the same way for 10 days on the second day after the next menstrual cycle.Both groups were treated for 3 menstrual cycles and followed up for 3 menstrual cycles after drug withdrawal.The endometrium was reviewed by transvaginal ultrasound before surgery,1 and 3 months after medication and 3 menstrual cycles after medication withdrawal,respectively,to determine the level of tumor necrosis factor-α.At the same time,the TCM syndrome was followed up,and the results were analyzed by statistical method.Results:1.After 1 month of treatment,endometrial thickness in both groups decreased to the normal range,and there was no significant difference between the two treatments(P>0.05).However,with the extension of treatment cycle,endometrial thickness between the two groups was different(P<0.05),endometrial thickness in the treatment group was thinner than that in the control group.In the treatment group,the recurrence rate of endometrial polyps was 6.25%(2/32)after 3 months of drug withdrawal,while in the control group,7 patients had endometrial thickening and uneven echo again,and 1 patient had intrauterine hyperecho again,with a recurrence rate of 26.7%(8/30),the difference was statistically significant(P<0.05),which shows that the recurrence rate of combined the treatment of TCM is lower than that of single-use dydrogesterone.2.Comparison of Tumor necrosis factor-α(TNF-α)level: After treatment,the level of TNF-α in the two groups of patients both decreased.Compared with before surgery,there were statistical differences(P<0.05),and the overall TNF-αlevel of the treatment group was lower than the control group,indicating that the effect of TCM combined treatment on reducing TNF-α level was better than that of dydrogesterone alone.The level of TNF-α in the treatment group was still different after 3 months of treatment and 3 months of discontinuation(P<0.05),but no difference was found in control group(P>0.05),indicating that the treatment group combined with TCM has a long-term effect on the decline of TNF-α level,and the control group no longer has a downward trend with the passage of time after drug withdrawal,and may have the risk of relapse.3.Comparison of TCM syndrome scores: After 1 month of treatment,the TCM syndrome scores of the two groups of patients had statistical differences,but the differences were not obvious(P=0.046<0.05),indicating that there was little difference in the short-term improvement of syndroms between the two methods.After 3 months of treatment and 3 months of drug withdrawal,the two groups of TCM syndrome scores had significant statistical differences(P <0.001),these results indicated that both methods had an effect on the improvement of TCM syndromes,but the overall TCM syndromes scores of the treatment group were lower than that of the control group,indicating that the effect of TCM combined treatment was better than that of dydrogesterone alone in improving TCM syndromes.4.Comparison of the efficacy of TCM syndromes: After 3 months of treatment,the total effective rate of TCM syndromes in the control group was 73.3%,while that in the treatment group was 90.6%,and there were significant statistical differences(P<0.001).The total efficiency of the treatment group was higher than that of the control group,it indicated that the combined treatment effect of TCM in the treatment group was better than that of single-ues dydrogesterone.Conclusion: Modified Qingre Tiaoxue Decoction combined with dydrogesterone can effectively inhibit postoperative abnormal endometrial hyperplasia in patients with damp-heat stasis type endometrial polyps after surgery,reduce the level of inflammatory factors in patients,improve the TCM syndromes of patients,and have a long-term efficacy compared with single-use dydrogesterone.It can significantly reduce the postoperative recurrence rate,good safety,worthy of clinical promotion. |
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