子宫内膜异位症性不孕的中西医治疗进展
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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.
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
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[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.
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[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.
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