用户名: 密码: 验证码:
不孕症的治疗进展及临床探讨
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
本文从文献综述与临床探讨两个方面讨论了无排卵、黄体功能不全、输卵
    管阻塞及抗精子抗体(AsAb)所致不孕症的治疗。
     综述部分:从辨证论治、中药人工周期疗法及中西医结合等方面概述了无
    排卵及黄体功能不全所致不孕的治疗;从内治法、外治法及内治外治相结合等
    方面概述了输卵管阻塞性不孕的治疗:从西医和中医两方面概述了抗精子抗体
    所致免疫性不孕的治疗,西医治疗包括局部隔绝法。兔疫抑制剂疗法及辅助生
    殖技术(ART),中医治疗包括辨证论治、专方专药、局部用药等。结论:补
    肾为主人工周期疗法与西药相结合是治疗无排卵性不孕的较好方法;补肾疏研
    与调周相结合,并辅以心理疏导是治疗黄体不健性不孕的较好方法;输卵管阻
    塞宜内治与外治相结合;中医药及ART是AsAb所致不孕的较好治疗方法。
     临床探讨部分:通过自己的临床实践,以辨病与辨证相结合,对排卵功能
    障碍性不孕,输卵管胞性不孕及免疫性不孕的治疗进行了探讨,并讨论了肝
    郁在不孕症发病与治疗中的作用。认为不孕症的治疗宜采用辨病与辨证相结
    合、补肾与调肝相结合,宏观辨证与微观辨证相结合及中西医相结合。
In this essay we study the treatment of infertility caused by anovulation、
     Luteal phase defect(LPD)、oviduct obstruction and antispenn antibody(AsAb) from
     two sides of recapitulate and clinical research.
     In the first part, the treatments of anovulation and LPD were recapitulated in the
     aspects of treatment based on differentiation、Traditional Chinese medicine(TCM)
     artificial cyclic therapy and the therapy of combining traditional Chinese and western
     medicine. We recapitulated the treatment of oviduct obstruction from oral
     administration of medicine and external treatment, and the therapy of infertility with
     AsAb from western medicine and 1CM. The treatments of western medicine include
     condom~ immunosuppressive therapy and assisted reproductive technology(ART),
     and the treatments of TCM include the treatment based on differentiation., the special
     prescription for the disease and so on. Conclusions: It is the better therapy of
     anovulatory infertility to combine cyclic therapy of toniyfing Kidneys with western
     medicine. The better therapy of LPD is integration tonifying Kidney and soothe Liver
     into psychological regulation. Treating oviduct obstruction should combine oral
     administration of medicine with external treatment. 1CM and ART can be used to
     treat the infertility of AsAb.
     In the second part, we study the treatment of infertility caused by the obstacle of
     ovulation., oviduct obstruction and immunology by combining differential diagnosis
     of disease with differential symptoms and signs, and research the role of Liver
     stagnation in pathogenesis and treatment of infertility, too. We think that we should
     treat infertility by combining differential diagnosis of disease with differential
     symptoms and signs mixing tonifying Kidney into dispersing the stagnated
     Liver-Qi Combining macrocosmic differential symptoms and signs with
     microcosmic differential symptoms and signs、integrating 1CM into western
     medicine.
引文
1.程泾主编.实用中西医结合不孕不育诊疗学.北京:中国中医药出版社,2000:1.
    2.罗丽兰主编.不孕与不育.北京:人民卫生出版社,1998:202.
    3.郑怀美主编.妇产科学.第3版,北京:;人民卫生出版社,1995:389.
    4.蔡勤华.调补肝肾法治疗无排卵不孕症52例.江苏中医,1998;19(2):24.
    5.卢金玉,王清华,蔡连香,等.补肾疏肝法治疗排卵功能障碍不孕症的临床观察.成都中医药大学学报,2000;23(1):14-15.
    6.桑海莉.中医综合疗法促排卵的临床研究.湖北中医杂志,1998;20(4):17-18.
    7.李小平.补肾育嗣汤治疗排卵障碍性不孕症20例.福建中医药.1992;23(1);14-16.
    8.庞保珍,赵焕云.祛痰补肾法治疗无排卵型不孕症67例疗效观察.浙江中医杂志,1996;31(11):496.
    9.吕春英,何丽娜,张思佳,等.补肾宁心法治疗无排卵型不孕症60例.新中医,1998;30(1):40-41.
    10.张映春,邵冬珊,梅振翼.中药人工周期疗法治疗不孕症研究进展.吉林中医药,1991;(5):39-40.
    11.吕春英夏桂成.补肾调周法治疗不孕症78例.新中医,1995;(11):34-35.
    12.马敏珠.补肾为主治疗排卵功能障碍不孕症102例.上海中医药杂志,1994;(3):26-27.
    13.张振雯,刘佳.三步曲治疗不孕症.新中医,1998;30(11):26-27.
    14.孙跃农.中药-人工周期治疗卵巢功能性不孕症23例.云南中医杂志,1994;15(1):8-9.
    15.粘琼琼,何艳珠.子宫颈粘液检查指导治疗不孕症200例.福建中医药,1999;31(1):12-13.
    
    
    16.王忠民.中西医结合治疗无排卵型不孕症临床观察.中医药学报,1999;(5):12-13.
    17.陈益心,钱祖淇.中西医结合治疗内分泌失调不孕症101例.上海中医药杂志,2000;(9):26-27.
    18.李秀梅,郭保瑞,中西医结合治疗女性排卵功能障碍.新中医,1997;29(6):41.
    19.鲍世平.中西医结合治疗排卵功能障碍不孕症36例。上海中医药杂志,2000;(2):36-37.
    20.许慧莉,韩桂珍.中药离子导入与内服诱发排卵的临床研究.湖北中医学院学报,2000;2(1):28-29.
    21.杨鉴冰.归肾丸加味治疗93例黄体功能不足之不孕症的观察.陕西中医学院学报,1998;21(4):16.
    22.沈坚华,李淑萍.活血化瘀法治疗黄体功能不全136例疗效观察.新中医,1996;(1):39-40.
    23.武保乡,陈凤芹,58例黄体功能不全的辨证治疗.上海中医药杂志,1990;(4):10.
    24.胥桂生.疏肝达木为主治疗黄体功能不全69例.新中医,1990;(10):35.
    25.潘意坚.寿胎丸加味治疗黄体功能不全性不孕38例.福建中医药,1995;26(4):25.
    26.李丹.补肾疏郁法治疗黄体功能不健不孕症的体会.山西中医,1992;8(5):32-33.
    27.阎乐法,周俊卿,陈炳兰.补肾疏肝法治疗黄体性不孕36例报道.潍坊医学院学报,1996;18(1):64.
    28.李祥云,刘健.扶黄煎为主治疗黄体不健型不孕症72例.中国医药学报,1991;6(2):34.
    29.夏桂成.补肾调周法治疗不孕症.南京中医学院学报,1991;7(1):1.
    30.胡烘瑞.温肾疏肝序贯法治疗黄体功能不全不孕51例.上海中医药杂志,
    
    1996;(6):30.
    31.梁君儿.从肝肾辨证治疗黄体功能不全36例.广西中医药,1992;15(6):11-12.
    32.吴志诚.疏肝补肾治疗黄体功能不全并不孕84例临床观察.实用中西医结合杂志,1997;10(3):267.
    33.杨慧珍.对50例黄体功能不全引起不孕的治疗.中医药研究,1990;(4):44.
    34.丁彩飞 徐迪明.中西医结合治疗黄体功能不全不孕症196例.浙江中医杂志,1998;33(1):14.
    35.李鉴湖.中西医结合治疗黄体功能不全性不孕症102例临床观察.新中医,1999;31(6):39.
    36.吕春英.50例肾虚肝郁不孕症患者人格结构分析.南京中医学院学报,1993;(4):17.
    37.姚石安.黄体不健74例临床观察和机理探讨.江苏中医,1989;(3):10.
    38.杨丹,雷贞武.输卵管性不孕的病因.实用妇产科杂志.1996;12(6):282.
    39.张新宽.辨证治疗输卵管阻塞性不孕症54例.陕西中医,1996;17(6):248.
    40.张振雯.三连法治疗输卵管性不孕症45例.新中医,1996;(11):41-42.
    41.周端求.活血化瘀法治疗输卵管阻塞不孕症56例.光明中医杂志,1997;(2):32-33.
    42.熊初利,曾日古,熊初英.疏肝活血法治疗炎症性输卵管阻塞性不孕症疗效观察.湖南中医学院学报,1997;17(2):27-28.
    43.门玲瑞,谷增庄,王建平.孕宝丹治疗输卵管阻塞不孕症126例.河北中医,1991;13(3):21.
    44.李秀云,李天升.疏通汤治疗输卵管阻塞110例疗效观察.新中医,1999;31(8):39.
    45.虎发光.暖宫排卵散热敷治疗输卵管不通130例.安徽中医学院学报,1993;12(3):21.
    
    
    46.黄莉萍,汤瑞云.超声学造影动态观察输卵管与中药通管920例.中西医结合杂志,1991;(11):683-684.
    47.崔岩,王奎斌.通管汤治疗输卵管阻塞103例.新中医,1995;(6):41.
    48.孙松龄.中药内服外敷治疗输卵管阻塞性不孕症76例.河南中医,1993;13(1):31-32.
    49.王子柱.中药保留灌肠治疗输卵管阻塞52例疗效观察.新中医,1994;26(4):38-39.
    50.石洁玉.中药保留灌肠治疗输卵管阻塞性不孕症37例.上海中医药杂志,1992;(12):13.
    51.秦月好,王臻,陈何红.输卵管阻塞100例临床疗效分析.河南中医,1995;15(1):34-35.
    52.万如忱,江建南.中药保留灌肠与中服治疗输卵管阻塞不孕症100例.甘肃中医学院学报,1990;(3):19.
    53.常玉清.中西医结合治疗输卵管炎性不孕50例.中西医结合杂志,1993;(9):557.
    54.赵凯.中药为主宫内及直肠内给药治疗输卵管梗阻35例.新中医,1996;(12):40.
    55.谭德梅,以中药宫内给药为主治疗输卵管不通16例.浙江中医杂志,1993;28(7):303.
    56.李英,李华.中西医结合治疗输卵管阻塞124例.山西中医,1999;15(6):20-21.
    57.刘茂林.34例输卵管阻塞的治疗体会.陕西中医学院学报,1992;(1):23.
    58.路荣岱.中药离子导入法治疗输卵管阻塞137例.中西医结合杂志,1991;(6):333.
    69.梁文珍.中西医结合治疗输卵管阻塞性不孕症121例临床观察.中国医药学报,1995;10(4):25-26.
    60.欧晓青.中西医结合治疗输卵管阻塞性不孕症120例.黑龙江中医
    
    药,1999;(6):15-16.
    61.陈筠.中西医结合治疗输卵管阻塞性不孕症106例.新中医,1996;(7):44.
    62.连方,赵斌,胡安常,等.导管扩张术和活血祛瘀中药治疗输卵管阻塞的临床研究.中西医结合杂志,1994;14(2):80-82.
    63.杜炜杰,汪晓菁.宫腔镜输卵管插管通液术治疗不孕症197例分析.生殖与避孕,1999;19(1):1-2.
    64.冀萍,周莉,王秀香,等.针灸治疗输卵管炎性阻塞性不孕症的临床研究.中国针灸,1996;(9):1-2.
    65.程丽娟,季丽伟.采用侧穹窿封闭治疗输卵管不通206例临床观察.实用中西医结合杂志,1995;8(9):533.
    66、罗丽兰主编.不孕与不育.北京:人民卫生出版社,1998:364.
    67、王梦玖主编.临床生殖免疫学,上海:上海科学技术出版社,2000:335-336.
    68. SetuMazumdar, Adam S, Levine. Antisperm antibodes: etiology, pathogenesis, diagnosis, and treatment. Fertil Steril. 1998; 70: 799-810.
    69.龙振州主编.医学免疫学.第二版,北京:人民卫生出版社,1998.
    70. Heas GG. Immunologic infertility:Which approach are best? Cotemp Obstet Gyncol. 1983; 22:141.
    71.罗颂平,张玉珍,梁国珍,等.免疫性自然流产与免疫性不孕的临床与实验研究.中医杂志,1997;38(6):351-354.
    72. Bronson R. Sperm antisbodies:Their role in infertility. Fertil steril, 1984;42:171.
    73. William H. Secretory immune system of the femal reproductive tract. Obstet and Gynecol,1988:1:56.
    74. Schumacher GFB. Immunology of spermatozoa and cervical mucous. Hum Reprod, 1988;3:289.
    75.Ulcova-Gallova. Local hydrocotisone treatment of sperm agglutinating antibodies in infertility women. Int J Fertil. 1988;33(6):421.
    
    
    76.Subbi Mathur. Clinical significance of sperm antibodies in infertility. Fertil steril, 1981; 136(4): 486.
    77.陈金荣,王陈仙,候思理.抗免汤治疗免疫性不孕不育临床观察.云南中医中药杂志,1999;20(5):26—27.
    78.王丽,黄萍,黄晓燕,等.1020例免疫性不孕患者的治疗结果分析.中华妇产科杂志,1999;34(4):234—235.
    79.汪李虎,林飞鸿.强的松大剂量递减疗法治疗男性免疫性不育.中国男科学杂志,2000;14(3):185—186.
    80. Shulman S. Immune in fertility and new approaches to treatment. Fertil steril, 1978;129(3):309.
    81. Heas GG Jr, Manganiello P. A double-blind, placebo-controlled study of the use of methylprednisolone in infertile men with sperm-associated immunoglobulins. Fertil Steril, 1987;47:295-301.
    82. Agarwal A. Treatment of immunological infertility by sperm washing and intrauterine insemination. Arch Ardrol, 1992;29:207-213.
    83. Moretti-Rojas I. Intrauterine insemination with washed human spermatozoa does not induce formation of antisperm antibodies. Fertil steril, 1990;53:180.
    84. Kutteh WH, Kilian M, Ermel LD, et al. Antisperm antibodies in infertile women:Subclass distribution of immunoglobulins (Ig) A antibodies and removal of IgA sperm-bound antibodies with a specific IgA_1 protease. Fertil steril, 1995;63:63-70.
    85. Panayiotis M, Zavos. Antisperm antibody treatment mode:levels of antisperm antibody after incubation with TEST-yolk buffer and futration using the SpermPrep TM method. Fertil steril, 1998:69:517-521.
    86. Lahteen maki A, Veilahti J, Hovatta O. Intra-uterine insemination versus cyclic low-dose prednisolone in couples with male antisperm antibodies. Hum Reprod,1995;10:142-147.
    
    
    87. Robinson JN, Forman RG, Nicholson SC. A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steriol for the treatment of autoimmune infertility. Fertil steril, 1995;63:1260-1266.
    88. Acosta AA. Assisted reproduction in the diagnosis and treatment of male factor. Obstet Gynecol Surv,1989;44(1):1.
    89. Acosta AA,Van der merwe JP, Doncel G. Fertilization efficiency of morphologically abnormal spermatozoa in assisted reproduction is further impaired by antisperm antibodies on the male partner's sperm. Fertil steril,1994;64:826.
    90. Pagidas K, Hemmings R, Falcone R, Miron P. The effect of antisperm antibodies in male or female partners undergoing in vitro fertilization-embryo transfer Fertil steril, 1994;62:363-369.
    91. Culligan PJ, Crane MM, Boone WR. Validity and cost-effectiveness of antisperm antibody testing before in vitro fertilization. Fertil steril,1998;69:894-898.
    92. Van der Merwe JP, Kruger TF, Windt ML. Treatment of male sperm autoimmunity by using the gamete intrafallopian transfer procedure with washed spermatozoa. Fertil steril,1990;53:682-687.
    93. Clarke GN. Intracy toplasmic sperm injection for treating infertility associated with sperm autoimmunity. Fertil steril, 1997;68:12-117.
    94.莫蕙,郭悲红.免疫性不孕(AsAb阳性)中医病机探讨.江苏中医,1998;19(12):8.
    95.周亚萍.益肾活血法治疗免疫性不孕临床观察.镇江医学院学报,1998;8(4):589.
    96.侯玲玲.女性免疫性不孕的治疗.中医杂志,1992;33(5):14.
    97.胡德宝,戴宁,李唯,等.免不1号治疗79例抗精子抗体阳性不育症的临床研究.生殖与避孕,1999;19(5):285—289.
    98.夏桂成.辨治妇女免疫性不孕症50例.中国医药学报,1990;5(6):43.
    
    
    99.李凤义.抗精子抗体阳性的中医分型.新中医,1995;27(9):37.
    100.朱惠云.辨证分型治疗女性抗精子抗体异常所致不孕与流产88例.广西中医药,1997;20(1):15.
    101.王忠民,刘茜.从肝论治女性免疫性不孕.贵阳中医学院学报,1994;16(4):43.
    102.林云仙.丹杞归芪汤治疗抗精子免疫性不孕17例.广西中医药,1995;18(5):239.
    103.梁文珍.补肾泻浊汤治疗免疫性不孕78例.新中医,1998;30(4):44.
    104.韩林.消抗方配合避孕套治疗抗精子抗体阳性298例.河北中医,2000;22(1):45.
    105.奚嘉.“茵芩汤”治疗女性AsAb阳性21例.江苏中医,1995;16(5):12.
    106.王珺.抑抗汤治疗免疫性不孕42例.四川中医,2000;18(12):32.
    107.陈晓平,陈旦萍,董桂红.固阴煎治疗免疫不孕症及对体液免疫的影响.中医杂志,1992;33(12):36.
    108.莫蕙.抑清汤治疗免疫性不孕症的疗效观察.南京中医药大学学报,1998;14(6):339—341.
    109.徐吉祥,张卫东.自拟消抗汤治疗抗精子抗体阳性60例.国医论坛,1991;11(1):46.
    110.曹淑俐.自拟消抗体汤治疗女性免疫性不孕症128例报告.安徽中医临床杂志,1997;1(3):140.
    111.陈旦萍,曹萍芳.免疫性不孕症的治疗及对IgA,IgG,IgM的观察.福建中医药,1999;30(5):4.
    112.李大金,李超荆,朱影.滋阴降火中药治疗免疫性不孕症.中国中西医结合杂志,1995;15(1):3.
    113.袁少英,抗阳助孕方为主治疗女性抗精子抗体阳性不孕症42例.上海中医药杂志,1997;(9):30.
    114.刘福阳,吴强,毕秋梅.孕宝治疗免疫性不孕102例分析.中国实用妇科
    
    与产科杂志,1997;13(3):168.
    115.赖安妮,宋济范,刘先菊,等.中药胎宝抑制抗精子抗体的实验研究.中国中西医结合杂志,1997;17(6):360—362.
    116.李祥兴,虞小霞.知柏地黄煎剂治疗免疫性不育的实验研究.中药新药与临床杂志,1997:8(2):83—85.
    117.周文隆,周爱萍.还精煎治疗免疫性不育的临床研究.生殖与避孕,1881;11(1):46.
    118.齐玲玲,刘春霞,胡吉英.中西医结合治疗免疫性不孕90例.山东中医杂志,2000;19(10):610.
    119.王县,肖俊楼,刘学枝,等.血清AsAb阳性80例治疗总结.中国计划生育学杂志,1998;8:373—374.
    120.顾美娟,庞玉和.中西医结合治疗免疫性不孕症18例.江苏中医,1998;19(5):26.
    121.陆华,刘敏如,李春梅.养精汤促卵泡发育的临床观察.中国中西医结合杂志,1998;18(4):217-220.
    122.赵瑞华,刘亚棉,杨琳,等.补肾调经汤促排卵的临床研究.中国中西医结合杂志,1996;16(5):264-266.
    123.廖玎玲.中药人工周期继发闭经妇女垂体GnH释放和贮备功能的影响.中西医结合杂志,1989;9(8):468.
    124.徐晋勋,周前贵,符式桂,等.“促卵泡汤”女性激素样作用的观察.中医杂志,1982;(1):65-66.
    125.奚明,符式桂,吴忠华,等.促黄体汤对假孕大鼠垂体卵巢轴的影响.中西医结合杂志,1988;8(2):101-102.
    126.阎乐法,左凤英,伦学斌.免疫性不育的中药治法和用药初探.甘肃中医,1995;8(2):35-36.
    127.杨丙辰,王秀霞,姚美玉.正常人及肝郁型月经前后诸症的PRL含量测定.新疆中医药,1988;(1):12-13.
    
    
    128.王希浩,贾可夫,何玉凡.从内分泌学探讨肝郁证月经病病机制.实用中西医结合杂志,1995;8(12):757-758.
    129.贾可夫,王希浩,宋红湘,等.舒肝法对肝郁证月经病血清PRL、E_2、P、E_2/P作用的研究.实用中西医结合杂志,1995;8(2):110-111.
    130.柴丽娜,杜惠兰.肝郁型月经病血液流变学及盆腔血流图的观察与分析.山东中医杂志,1997;16(2):61-62.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700