A Postoperative Follow-up Study On Traditional Chinese Medicine Or Traditional Chinese Medicine And Western Medicine Intervention Of Tubal Infertility

ObjectiveRetrospective research methods were performed for collecting clinical information in our hospital from Jan.2008to Dec.2010of the tubal infertility or the tubal obstruction patients, who were treated by laparoscopy, Hysteroscopy combined Laparoscopy, interventional therapy or laparoscopy combined interventional therapy, analyzing the differences among hospitalization days and total expenses, operation charges and recanalization rates of oviduct operation of different operative methods. At meanwhile, made tracks of the rates of postoperative pregnancy, abortion and exfetation one year later, and made a statistic analysis about the distribution characteristic of preoperative and postoperative TCM syndromes, so that we can provide some clinical basic information for TCM therapy of tubal infertility, and provide some information for reference about how to choose the operative method so that can achieve the best treated effect and cut down the survey costs for patients.MethodsUsing the retrospective research methods to collect the information of354patients who were diagnosed as tubal infertility or tubal obstruction in the operation, as well as were treated by laparoscopy, Hysteroscopy combined Laparoscopy, interventional therapy or laparoscopy combined interventional therapy, collecting information of patients’hospitalization days and total expenses, operation charges, oviduct function scores in the operation, degrees of pelvic cavity conglutination and the distribution of TCM syndromes etc. Followed up information of TCM and Western medicine therapy, pregnancy after one year’s discharge. Results1.354tubal infertility or tubal obstruction patients were all investigated in the survey. Of all the patients,199of whom were cured by laparoscopy,36were cured by oviduct retrocatheterism using hysteroscopy and laparoscopy,104were cured by oviduct interventional treatment,15were cured by laparoscopy and oviduct interventional treatment. Their ages ranged from20to42, and the average age was30.10±4.384.II. In the survey of combined Gynecological disease, mycoplasma infection and hysteromyoma were the commonest.III. Analysis of TCM syndromes:1) In the preoperative TCM syndromes,74.0%out of354patients were suffered from stagnation of Qi and blood stasis,13.0%of them were Kidney Deficiency and blood stasis,4.8%of them were Qi asthenia and blood stasis,3.4%of them were Spleen Deficiency and dampness stasis.2) In Phase1of postoperative TCM syndromes,87.2%out of250patients who were treated by laparoscopy were suffered from obstruction of Fu-qi,4.8%of them were Spleen Deficiency. In Phase1of the TCM syndromes,72.3%out of119patients who were treated by oviduct interventional treatment were suffered from stagnation of Qi and blood stasis,12.6%of them were Kidney Deficiency and blood stasis. In Phase2of TCM syndromes,20.3%out of250patients after the laparoscopy were suffered from stagnation of Qi and blood stasis,18.9%of them were Spleen Deficiency,13.5%of them were Qi asthenia and blood stasis,10.8%of them were Spleen Deficiency and dampness stasis,8.1%of them were Spleen Deficiency and blood stasis,5.9%of them were Spleen Deficiency and dampness.86.6%out of119patients who were treated by oviduct interventional therapy didn’t have the treatment based on syndrome differentiation in Phase2.IV. In contrast with rates of the oviduct recanalization of the four operative methods, the rate in Group laparoscopy was90.9%, and80.7%in Group hysteroscopy and laparoscopy,86.4%in Group oviduct interventional treatment and75.9%in Group laparoscopy and oviduct interventional treatment. The differences of the rates of the groups were statistically significant (P<0.05).V.1)In the survey of hospitalization days,353patients were investigated and there were differences in the four operative methods(P<0.05). The days of hospitalization of Group oviduct interventional treatment which was5.64±1.487days was the least,while that of Group laparoscopy and oviduct interventional treatment which was9.50±1.787days was the most.2)353patients were investigated in the research of total hospitalization expenses. There were also differences in the four operative methods(P<0.05). The total hospitalization expenses of Group oviduct interventional treatment which was5318.28±653.66yuan was the cheapest, while that of Group laparoscopy and oviduct interventional treatment which was12817.85±1908.87yuan was the most expensive.3)139patients were investigated in the research of operation charges. There were significant differences in the operation charges of the three groups which were Group laparoscopy, Group hysteroscopy and laparoscopy and Group oviduct interventional treatment. And Group oviduct interventional treatment which spent2000.00±0.00yuan cost the least.Ⅵ.250patients were investigated in postoperative flatus and defecation time. The differences in them were not statistically significant(P>0.05). between the three groups which were Group laparoscopy, Group hysteroscopy and laparoscopy, Group laparoscopy and oviduct interventional treatment.Ⅶ. Analysis of the pregnancy results:1)121out of354patients were pregnant after the operation one year later (34.2%),110of them were pregnant in a natural way (31.1%),11were pregnant by IVF-ET(3.1%).92out of121pregnant women were postoperatively intrauterine, while the other29were exfetation.72out of92intrauterine pregnant women did not have an abortion, while the other20did.2)The comparison of the pregnant time and the rates of natural pregnancy after one year by using different operative methods between the groups were not statistically significant(P>0.05).But it was in postoperative pregnant time which treated in different hospitals after the discharge(P<0.05). The average postoperative pregnant time in Guangdong Provincial Hospital of TCM which was5.15±3.357months was the shortest, while that in Guangdong Provincial Hospital of TCM together with other hospital which was10.67±2.121months was the longest.3)Analyzing the factors which affected the postoperative natural pregnancy, I found out that the total scores of the bilateral oviduct function do good to the arrival of natural pregnancy and the decrease of its time, while that the time of uncontraception does not.4)They were not statistically significant in the comparison of the pregnant places and the postoperative abortion of the four operative methods (P>0.05). It was not statistically significant in the pregnant places of different degrees of the pelvic cavity conglutination, neither. But it was in the pregnant places of the total scores of bilateral oviduct function of the250patients who were treated by laparoscopy.Ⅷ. Only one patient in Group Laparoscopy had a postoperative lung infection in all the four groups in hospitalization.ConclusionsⅠ. Laparoscopy makes a pretty good effect on the oviduct recanalization rate of distal oviduct obstruction;the oviduct interventional treatment makes an excellent effect on the oviduct recanalization rate of proximal oviduct obstruction. The oviduct retrocatheterism combined laparoscopy using hysteroscopy makes no effect on the oviduct recanalization rate of proximal or incorporated distal oviduct obstruction, oviduct interventional treatment makes no effect on the oviduct recanalization rate of proximal oviduct obstruction, neither.But the recanalization rates of the above-mentioned two are lower than that of the distal oviduct obstruction patients who were treated by laparoscopy. The hospitalization days and total expenses of the patients who were treated by oviduct interventional treatment were the least, while those who were treated by laparoscopy combined oviduct interventional treatment were the most. Integrating the factors of clinical effects and economy etc. the oviduct interventional therapy can be used widely in the patients who are proximal oviduct obstruction; while Laparoscopy can be used widely in the patients who are distal oviduct obstruchtion.Ⅱ. Blood Stasis in Chong Ren uterine vessels was the basic pathogenesis of tubal infertility and oviduct obstruction while Qi stagnation and blood stasis was the commonest syndrome of those patients.Ⅲ.1)The primary preoperative syndrome was Qi stagnation and blood stasis.2)The postoperative syndromes:the postoperative syndromes of the patients who were treated by laparoscopy can be divided into2stages. Stage1was considered to be the sufficiency syndrome, especially the Fu-qi stagnation. There was not only sufficiency syndrome but also deficiency syndrome of TCM syndrome in stage2. But the deficiency syndrome was primary, such as Qi stagnation and blood stasis, spleen deficiency, Qi deficiency and blood stasis, spleen deficiency and dampness stasis, spleen deficiency and blood stasis, spleen deficiency and dampness.The primary postoperative syndrome transfered from sufficiency to deficiency.The syndromes of the patients who were treated by oviduct interventional treatment had little difference before or after the operation.IV. Of all the patients who were tubal infertility or oviduct obstruction, the scores of bilateral oviduct function do good to the natural pregnancy and the decrease of its time.