摘要
子宫内膜异位症作为妇科常见的慢性病、疑难杂症除引起盆腔痛、性交痛、月经异常外,还可引起不孕症。子宫内膜异位症引起不孕的生物学机制复杂,至今尚未阐明。该病严重影响女性的身心健康,因此当务之急是寻求有效、可提高生育力的治疗方法。近年来现代医学及祖国医学对子宫内膜异位症引起不孕的治疗不断发展,包括期待治疗、药物治疗(如高孕激素、促性腺激素释放激素激动剂等)、手术治疗(如开腹手术、腹腔镜以及超声引导下的穿刺术)、手术联合药物治疗及中医内治法和外治法,但各有其局限性。
In addition to pelvic pain,intercourse pain and menstrual abnormalities,endometriosis as a common chronic and difficult miscellaneous gynecologic disease,can lead to infertility. The biological mechanism of endometriosis causing infertility is complex,which has not been clarified so far. The disease seriously affects women's physical and mental health,so it is an urgent task to find effective and fertility-enhancing treatment methods. In recent years,modern medicine and Chinese medicine have been developing for the treatment of endometriosis infertility,which include anticipated treatment,drug therapy( such as high progesterone,gonadotropin releasing hormone),surgical treatment( such as open surgery,laparoscopic surgery,ultrasound-guided puncture),surgical combined drug therapy,and internal and external treatment of traditional Chinese medicine,though each has its own limitation.
引文
[1]石一复,郝敏.子宫内膜异位症诊疗新进展[M].北京:人民军医出版社,2014:143,237.
[2]乔杰.生殖医学临床指南与专家解读[M].北京:人民军医出版社,2014:14-25.
[3]徐献丽,时燕萍.中医治疗子宫内膜异位症性不孕症[J].长春中医药大学学报,2015,31(4):741-743.
[4]Ozkan S,Murk W,Arici A.Endometriosis and infertility:Epidemiology and evidence-based treatments[J].Ann N Y Acad Sci,2008,1127:92-100.
[5]Macer ML,Taylor HS.Endometriosis and infertility:A review of the pathogenesis and treatment of endometriosis-associated infertility[J].Obstet Gynecol Clin North Am,2012,39(4):535-549.
[6]汤丽荣,卢丹,段爱红.子宫内膜异位症合并不孕患者治疗后期待妊娠情况分析[J].北京医学,2011,33(4):306-309.
[7]杨丽娟.子宫内膜异位致不孕的原因分析及其处理对策[J].中国继续医学教育,2016,8(14):96-97.
[8]吴莺,王燕,段洁,等.采用腹腔镜手术和口服避孕药的方法治疗轻度子宫内膜异位症合并不孕症的效果分析[J].当代医药论丛,2016,14(5):122-123.
[9]de Ziegler D,Gayet V,Aubriot FX,et al.Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes[J].Fertil Steril,2010,94(7):2796-2799.
[10]Minas V,Dada T.Laparoscopic treatment of endometriosis and effects on quality of life:A retrospective study using the short form EHP-5 endometriosis specific questionnaire[J].J Obstet Gynaecol,2014,34(4):336-340.
[11]曹瑞勤.腹腔镜手术联合孕三烯酮治疗子宫内膜异位症伴不孕症的疗效及其对卵巢功能的影响[J].广西医学,2014,36(3):318-321.
[12]Sallam HN,Garcia-Velasco JA,Dias S,et al.Long-term pituitary down-regulation before in vitro fertilization(IVF)for women with endometriosis[J/CD].Cochrane Database Syst Rev,2006(1):CD004635.
[13]Benschop L,Farquhar C,van der Poel N,et al.Interventions for women with endometrioma prior to assisted reproductive technology[J/CD].Cochrane Database Syst Rev,2010(11):CD008571.
[14]张璇,舒慧芳,赵翠柳,等.轻度子宫内膜异位症伴不孕腹腔镜术后辅助治疗对妊娠的影响[J].中国妇幼保健,2009,24(14):1905-1906.
[15]Kolibianakis E,Bourgain C,Albano C,et al.Effect of ovarian stimulationwith recombinant follicle-stimula-ring hormone,gonadotropin releasing hormone antagonists,and human chorionie gonadotropin on endometrialmaturati on the day of oocyte pick up[J].Fertil Steril,2002,78(5):1025-1029.
[16]李苗,邸媛媛,邓清华,等.子宫内膜异位症并不孕患者血清内分泌激素水平及自身免疫抗体分析[J].中国妇幼保健,2018,33(14):3274-3276.
[17]付楝.补肾调经汤内服对子宫内膜异位症体液免疫及异位子宫内膜的影响[J].陕西中医,2016,37(8):1051-1052.
[18]Taylor HS,Osteen KG,Bruner-Tran KL,et al.Novel therapies targeting endometriosis[J].Reprod Sci,2011,18(9):814-823.
[19]Rocha AL,Reis FM,Petraglia F.New trends for the medical treatment of endometriosis[J].Expert Opin Investig Drugs,2012,21(7):905-919.
[20]Jin X,Ruiz Beguerie J.Laparoscopic surgery for subfertility relatedto endometriosis:A meta-analysis[J].Taiwan J Obstet Gynecol,2014,53(3):303-308.
[21]Jacobson TZ,Duffy JM,Barlow DH,et al.WITHDRAWN:Laparoscopic surgery for subfertility associated with endometriosis[J/CD].Cochrane Database Syst Rev,2014(8):CD001398.
[22]辛慧静,马春芹.腹腔镜和开腹手术治疗子宫内膜异位症伴不孕患者的疗效比较[J].实用妇科内分泌杂志,2018,5(8):103-104.
[23]王彧,范可心.腹腔镜手术与开腹手术治疗子宫内膜异位症性不孕的疗效比较[J].中国妇幼保健,2014,29(4):630-632.
[24]郝玉珍,胡西凤,冀秋凤.腹腔镜下囊肿剥除术和阴道超声引导下囊肿穿刺术治疗卵巢子宫内膜异位囊肿的疗效观察[J].西北国防医学杂志,2016,37(12):847-848.
[25]陈淑红.介入超声对卵巢子宫内膜异位囊肿的治疗分析[J].实用妇科内分泌杂志,2017,4(3):42-43.
[26]邓咏诗,张清宇.超声引导下穿刺术对巧克力囊肿的诊治价值[J].中国现代药物应用,2016,10(4):94-95.
[27]杨冰,尹茳平,李昱川,等.子宫内膜异位症术后辅助治疗对患者生活质量影响的评价[J].第三军医大学学报,2015,37(23):2409-2410.
[28]Dunselman GA,Vermeulen N,Becker C,et al.ESHRE guideline:Management of women with endometriosis[J].Hum Reprod,2014,29(3):400-412.
[29]王敬华,祁建青,任琼珍.子宫内膜异位症伴不孕患者经腹腔镜手术和开腹手术治疗的临床疗效比较[J].中国妇幼保健,2015,30(9):1353-1355.
[30]方淑芬,万玉珍.子宫内膜异位症合并不孕的患者经过腹腔镜手术后自然妊娠与妊娠结局的影响因素[J].中国医学创新,2018,15(29):5-9.
[31]窦秀芹.子宫内膜异位症合并不孕患者腹腔镜术后联合药物治疗对妊娠结局的影响分析[J].中国现代药物应用,2018,12(21):124-125.
[32]陈彩江.腹腔镜联合药物治疗子宫内膜异位症合并不孕的临床效果评价[J].中国现代药物应用,2017,11(20):134-135.
[33]周明,陈丹丹,王丽娜,等.腹腔镜联合GnRH-a治疗Ⅰ期子宫内膜异位症不孕的临床研究[J].腹腔镜外科杂志,2016,21(12):948-950.
[34]Yap C,Furness S,Farquhar C.Pre and post operative medical therapy for endometriosis surgery[J/CD].Cochrane Database Syst Rev,2004(3):CD003678.
[35]Rossi AC,Prefumo F.The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer:A systematic review and meta-analysis[J].Arch Gynecol Obstet,2016,294(3):647-655.
[36]郝立爽,谭丽,张婷婷.中药对子宫内膜异位症患者有关不孕的治疗进展[J].中国中医基础医学杂志,2013,19(2):228-230.
[37]徐冰.金铃子散合四逆散加减治疗子宫内膜异位症致不孕临床研究[J].陕西中医,2017,38(5):627-629.
[38]李艳青,林晓华,许志娟,等.莪术消癥丸治疗气滞血瘀型子宫内膜异位症临床疗效分析[J].中日友好医院学报,2016,30(1):20-22.
[39]李小平,林靓.木达汤治疗肝郁气滞血瘀型EM排卵障碍性不孕30例疗效观察[J].福建中医药大学学报,2013,23(6):58-59.
[40]潘芳,杨优洲,王继波,等.温肾活血方治疗寒凝血瘀型子宫内膜异位症不孕患者的临床观察[J].上海中医药大学学报,2014,28(1):46-49.
[41]刘勇,王蕊,邢红梅.温经和营方对子宫内膜异位症不孕患者排卵功能的影响[J].河北中医药学报,2009,24(3):13-14.
[42]严春玲.王成荣学术思想辨治经验概要验证巧探[D].成都:成都中医药大学,2016.
[43]姚佳.异位散治疗子宫内膜异位症疗效观察[J].中医临床研究,2014,6(1):26-27.
[44]沈萍,章丽娅,董丽君.益气化瘀法治疗子宫内膜异位症气虚血瘀证的临床研究[J].贵阳中医学院学报,2014,36(4):98-100.
[45]王欣.复方莪术散治疗肾虚血瘀型子宫内膜异位症74例小结[J].湖南中医杂志,2016,32(5):70-71.
[46]杨琪.温肾化瘀法治疗肾虚血瘀型子宫内膜异位性疾病的临床观察[D].北京:北京中医药大学,2017.
[47]夏桂成.夏桂成实用中医妇科学[M].北京:中国中医药出版社,2009:214-215.
[48]张娟,赵瑞华.活血补肾周期治疗子宫内膜异位症相关不孕症临床观察[J].中国中医药信息杂志,2014,21(4):93-95.
[49]刘海燕,陈秀英,张蓉,等.补肾祛瘀法分期治疗子宫内膜异位症性不孕临床疗效观察[J].中国中医药信息杂志,2013,20(3):82-83.
[50]张澎,范郁山,苗芙蕊.中药灌肠治疗子宫内膜异位症的研究进展[J].湖南中医杂志,2017,33(9):198-199.
[51]徐云香.中药灌肠治疗子宫内膜异位症相关不孕临床观察[J].实用中医药杂志,2011,27(3):153-154.
[52]吴红野.中药灌肠治疗子宫内膜异位症性不孕33例观察[J].中国现代医生,2009,47(13):77-78.
[53]沈群,陆菁.针灸治疗子宫内膜异位症临床观察[J].上海针灸杂志,2017,36(6):711-714.
[54]徐林林.活血化瘀方对EMs不孕腹腔镜保守性手术后妊娠率及复发的影响[D].武汉:湖北中医药大学,2014.
[55]陈小平,陈靓芬,黄丽萍.活血化瘀中药联合腹腔镜手术对子宫内膜异位症不孕患者MCP-1、RANTES、氧化应激及性激素水平的影响[J].中国实验方剂学杂志,2013,19(4):319-322.
[56]吴琳,魏栋辉.腹腔镜手术配合中药治疗对子宫内膜异位症伴不孕患者症状及妊娠结局的影响[J].临床医学研究与实践,2018,3(2):54-55.
[57]付蒙,吕晓杰.地屈孕酮片联合中药人工周期治疗子宫内膜异位症致不孕疗效观察[J].临床研究,2017,26(11):44-46.
[58]周晓红,傅文君,王宝娣,等.雷公藤多苷联合孕三烯酮对子宫内膜异位症及血清细胞因子表达的临床研究[J].中国中药杂志,2016,41(18):3478-3482.
[59]侯常,柴洪佳,邹志洁,等.中药配合人工授精对子宫内膜异位症腹腔镜术后患者的疗效[J].实用临床医学,2013,14(1):67-70.