围绝经期子宫切除术后绝经前后诸证辨证分析
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摘要
目的:
为探讨妇科子宫切除手术卵巢去留对女性围绝经期的影响,并探讨不同手术方式术后出现绝经前后诸证的中医辨证分析。
方法:
1.研究对象
收集2005年7月-2007年12月因在湖北省中医院妇科收治并手术的138例围绝经期子宫切除患者病案资料的回顾性研究,绘制调查表,调查内容包括一般情况、手术方式、病检结果、Kupperman评分、出现绝经前后诸证的中医辨证等。并将所得资料分为两组,以单纯切除子宫的为A组,子宫+双侧附件切除的为B组。
2.观测指标:
比较两组子宫切除术后围绝经期综合征的发生率,最早出现症状的时间、程度,并对两组出现围绝经期综合征的患者进行中医辨证分析。
结果:
1.A组与B组术后均有围绝经期综合征出现,两组发生率有显著性差异(P＜0.05)。
2.术后两组最早出现症状的时间有显著性差异(P＜0.05)。
3.两组围绝经期综合征程度比较,有显著性差异(P＜0.05)。
4.两组术后出现围绝经期综合征KUPPERMAN评分有显著性差异(P＜0.05)。
5.两组术后出现围绝经期综合征中医证型比较有显著性差异(P＜0.05)。
结论:
本研究表明双侧附件切除后围绝经期综合征的发生率高于双侧附件保留者,且双侧附件切除患者更年期症状出现时间早,症状严重。并对术后两组绝经前后诸证辨证分型结果表明,保留双侧附件患者主要表现为肾阴虚型,切除双侧附件患者主要表现为肾阴阳两虚型。保留双侧附件有利于子宫切除术后患者的生活质量的提高。
Objective:
To explore influence of Ovary during in perimenopause, and Chinese medicine-discrimination analysis on postoperative perimenopausal syndrome.
Method:
1.research object
Collection the date of 138 cases with post-hysterectomy in perimenopausal women who were admitted from 2005.7 to 2007.12, Drawing Questionnaire,General condition,pathological examination, Kupperman scoring method,TCM symptoms,Methods The 138 cases undergoing excision of bilateral accessory or not divided into two groups,92 cases as A group(excision group),40 cases as B group (preservation group),and analysis the result in statistics,and Analysis of TCM syndromes of Postoperative Perimenopause Syndrome.
2.Observation Indicator
Comparison the incidence rates of Perimenopause Syndrome of two groups,and the relationship of the appearance and the degree of Perimenopause Syndrome.
syndrome differentiation and typing of Postoperative Perimenopause Syndrome in two groups,And Comparison the prevalence of two groups'.
5.statistical treatment
Results:
1.Perimenopause syndrome appeared in 2 groups of post-hysterectomy, there was significant difference between two groups(P＜0.05).
2.there was significant difference between two groups about the time (P＜0.05).
3.there are siginificant difference between the two groups about the degree of Perimenopause Syndrome(P＜0.05).
4.there are siginificant difference between the two groups about the kupperman' s soring(P＜0.05).
5.there are siginificant difference between the two groups about the TCM Syndrome type(P＜0.05).
Conclusion:
This study showed that the incidence of Perimenopause Syndrome is higher in excision of bilateral accessory than in preservation, the symptoms of Perimenopause Syndrome appeared earlier and the degree is more severe than the preservation' s.Analysis on Perimenopause Syndrome of two groups in syndrome differ classification,and the results showed that the main manifestation of preservation of bilateral accessory is kidney yin deficiency,but excision of which is kidney-yin and yang deficiency.
为探讨妇科子宫切除手术卵巢去留对女性围绝经期的影响,并探讨不同手术方式术后出现绝经前后诸证的中医辨证分析。
方法:
1.研究对象
收集2005年7月-2007年12月因在湖北省中医院妇科收治并手术的138例围绝经期子宫切除患者病案资料的回顾性研究,绘制调查表,调查内容包括一般情况、手术方式、病检结果、Kupperman评分、出现绝经前后诸证的中医辨证等。并将所得资料分为两组,以单纯切除子宫的为A组,子宫+双侧附件切除的为B组。
2.观测指标:
比较两组子宫切除术后围绝经期综合征的发生率,最早出现症状的时间、程度,并对两组出现围绝经期综合征的患者进行中医辨证分析。
结果:
1.A组与B组术后均有围绝经期综合征出现,两组发生率有显著性差异(P＜0.05)。
2.术后两组最早出现症状的时间有显著性差异(P＜0.05)。
3.两组围绝经期综合征程度比较,有显著性差异(P＜0.05)。
4.两组术后出现围绝经期综合征KUPPERMAN评分有显著性差异(P＜0.05)。
5.两组术后出现围绝经期综合征中医证型比较有显著性差异(P＜0.05)。
结论:
本研究表明双侧附件切除后围绝经期综合征的发生率高于双侧附件保留者,且双侧附件切除患者更年期症状出现时间早,症状严重。并对术后两组绝经前后诸证辨证分型结果表明,保留双侧附件患者主要表现为肾阴虚型,切除双侧附件患者主要表现为肾阴阳两虚型。保留双侧附件有利于子宫切除术后患者的生活质量的提高。
Objective:
To explore influence of Ovary during in perimenopause, and Chinese medicine-discrimination analysis on postoperative perimenopausal syndrome.
Method:
1.research object
Collection the date of 138 cases with post-hysterectomy in perimenopausal women who were admitted from 2005.7 to 2007.12, Drawing Questionnaire,General condition,pathological examination, Kupperman scoring method,TCM symptoms,Methods The 138 cases undergoing excision of bilateral accessory or not divided into two groups,92 cases as A group(excision group),40 cases as B group (preservation group),and analysis the result in statistics,and Analysis of TCM syndromes of Postoperative Perimenopause Syndrome.
2.Observation Indicator
Comparison the incidence rates of Perimenopause Syndrome of two groups,and the relationship of the appearance and the degree of Perimenopause Syndrome.
syndrome differentiation and typing of Postoperative Perimenopause Syndrome in two groups,And Comparison the prevalence of two groups'.
5.statistical treatment
Results:
1.Perimenopause syndrome appeared in 2 groups of post-hysterectomy, there was significant difference between two groups(P＜0.05).
2.there was significant difference between two groups about the time (P＜0.05).
3.there are siginificant difference between the two groups about the degree of Perimenopause Syndrome(P＜0.05).
4.there are siginificant difference between the two groups about the kupperman' s soring(P＜0.05).
5.there are siginificant difference between the two groups about the TCM Syndrome type(P＜0.05).
Conclusion:
This study showed that the incidence of Perimenopause Syndrome is higher in excision of bilateral accessory than in preservation, the symptoms of Perimenopause Syndrome appeared earlier and the degree is more severe than the preservation' s.Analysis on Perimenopause Syndrome of two groups in syndrome differ classification,and the results showed that the main manifestation of preservation of bilateral accessory is kidney yin deficiency,but excision of which is kidney-yin and yang deficiency.
引文
[1]曹泽毅主编.《中华妇产科学》(M).北京:人民卫生出版社,2005
[2]马宝璋主编.中医妇科学(M).北京:中国中医药出版社,2004
[3]山东省卫生厅.实用中西医结合诊断治疗学.山东:山东科学技术出版社,2006
[4]张惜阴主编.实用妇产科学(M).北京:人民卫生出版社,2004
[5]Steven A,Boyd J.Current understanding of the epidemiology and clinical implication of BRCA2 mutations for ovarian cancer.Curr Opin Ostet Gynecol,2002,14:19-26
[6]李美蓉.更年期和老年期妇女常见病的现代诊断与治疗.北京:中国医药科技出版社,2001:161-172
[7]胡随瑜,尤劲松,向群辉等.地贞颗粒对“更年期”拟阴虚内热证模型大鼠的影响.中药新药与临床药理,2000;11(3):143-145
[8]范红霞,万力生,黎烈荣.更年安怡片对去卵巢大鼠脑组织中单胺类神经递质含量的影响.中医研究,1999;12(6):11-1320
[9]陈亚琼,叶雪清.血浆吲哚类神经递质与更年期综合征症状的相关分析.中华妇产科杂志,1996;31(1):41-42
[10]王大增,朱燕青,李燕萍等.更年舒治疗妇女更年期综合征的临床及实验研究.中国中西医结合杂志,1994;14(7):396-399
[11]尤劲松,胡随瑜,向群辉等.地贞颗粒对更年期拟阴虚内热证大鼠儿茶酚胺递质及促性腺激素水平的影响.湖南医科大学学报,2001;26(1):33-36
[12]易绍东,阮云军,董凤英等.雌激素对去卵巢大鼠血清一氧化氮和内皮素水平的影响.中国医师杂志,2001;3(5):339-340
[13]谈勇,许小凤,卢苏等.围绝经期综合征患者ET、NO的水平与中药替代治疗的研究.中国医刊,2001;36(12):45-47
[14]徐丙兰,钱俊华.古今中医妇科病辨证精要.人民军医出版社.2007
[15]罗元恺,等.以补肾为主治疗更年期综合征临床研究.中国医药学报,1990(2):23
[16]梅乾茵.黄绳武妇科经验集.人民卫生出版社.2006
[17]罗春艳,周世超.吴克明辨治围绝经期综合征经验撷菁.江西中医药2008年6月第6期总39卷第306期
[18]洪颖,胡志泌,许传芳.卵巢切除与更年期综合征的关系[J].中国实用妇科与产科杂志.1996,12:350-352
[1]石一复.子宫肌瘤的发病率及病因病机(J).中国医刊.2002,37(4):11-12
[2]杨燕飞等.子宫肌瘤患病年龄分布与追踪研究.[J].实用妇产科杂志.2008,24(5):299
[3]Parkin DM,Bray F,Ferlay J,et al.Global cancer statistics,2002[J].CA Cancer J Clin,2005,55:74-108.
[4]臧荣余.卵巢癌预防研究在欧美.肿瘤学杂志.2006,2(12):107
[5]因良性病变行子宫切除时保留卵巢[英]/Parker WH…//Obs tet Gynecol.-2005,106(2).-219-226
[6]Kauff N,Satagopian J,Robson M,et al.Risk educingsalpingo-oophorectomy in women with a BRCA1 or BR-CA2mutation[J].N Engl J Med,2002,346:1609-1615.
[7]蒙晓玲.子宫及卵巢切除术对女性内分泌和性功能的影响.医学与哲学(临床决策论坛版).2006,4(27)
[8]吴桂珠,郑秀,王金华.子宫肌瘤867例临床分析.福建医药杂志.2004,6(26):142-143
[9]康德英,张国翔,郭伟.子宫肌瘤子宫切除时卵巢去留问题的探讨.山东医药.2002,20(42):54-55
[10]李丹,丁国莉.妇科手术对卵巢保留问题的临床与病理分析.黑龙江医学.2002,3(26):169
[11]薛梅,邹吟.子宫切除术中卵巢处理方式对内分泌的近期影响.上海第二医科大学学报.2003,1(28)
[12]王颖梅,薛凤霞.预防性卵巢切除的热点问题.现代妇产科进展.2005.14(3):235-238
[13]Berek Jonathan S.NOVAK妇科学(M).北京:人民卫生出版社,2005:512
[14]Steven A,Boyd J.Current understanding of the epidemiology and clinical implication of BRCA2 mutations for ovarian cancer.Curr Opin Ostet Gynecol,2002,14:19-26
[15]郑萍,王淑兰,高晓秋,等.子宫切除术后对卵巢功能的影响.首都医大学报,2000,12(4):335-337
[16]蔡桂茹.关于预防性卵巢切除的问题,国外医学计划生育妇产科学分册,1975,(2):105.
[17]蔡裴西·子宫良性病变手术时卵巢的去留问题[J]·中华妇产科杂志,1984,19(2):16·
[18]陈丹光·卵巢切除后内分泌和生化学变化[J]·中华妇产科杂志,1987,22(5):281·
[19]林仲秋·卵巢良性肿瘤剔除术的评价[J]·中华妇产科杂志,1989,24(4):228·
[20]蒋味根·妇科良性肿瘤手术时卵巢去留问题[J]·实用妇科与产科杂志,1987,3(5):229·
[21]焦书竹·子宫肌瘤的子宫切除术式与卵巢去留的探讨[J]·中华妇产科杂志,1984,19(2):71·
[22]张爱红,王聚宏.子宫切除术有关问题的商榷.中国厂矿医学.2 002年,5(15)
[23]姜静,张川利,王毅.子宫切除术后卵巢功能变化的观察.实用妇产科杂志,2005,21(10):630
[24]SiddleN,SarrleP,WhiteheadM.The effects of hysterectomy on the age at ovarian failure:identification of a Subgroup of wonmen with premature loss of ovarian function.Feritl steril,1987,47(1):94
[25]艾浩,薛晓鸥,温玉库等.绝经前单纯子宫切除对卵巢功能的研究.中国妇产科临床杂志,2004,5(6):413-415。
[26]邓君碧.卵巢切除后的内分泌变化.实用妇产科杂志,1992,260-262
[27]史金凤,尹伶,濮德敏.子宫肌瘤病因及发病机理研究进展
[28]洪颖,胡志泌,许传芳.卵巢切除与更年期综合征的关系[J].中国实用妇科与产科杂志.1996,12:350-352
[29]曹美良.不同术式切除子宫,卵巢对内分泌及更年期症状的影响.实用妇产科进展,2000,16(2):79
[2]马宝璋主编.中医妇科学(M).北京:中国中医药出版社,2004
[3]山东省卫生厅.实用中西医结合诊断治疗学.山东:山东科学技术出版社,2006
[4]张惜阴主编.实用妇产科学(M).北京:人民卫生出版社,2004
[5]Steven A,Boyd J.Current understanding of the epidemiology and clinical implication of BRCA2 mutations for ovarian cancer.Curr Opin Ostet Gynecol,2002,14:19-26
[6]李美蓉.更年期和老年期妇女常见病的现代诊断与治疗.北京:中国医药科技出版社,2001:161-172
[7]胡随瑜,尤劲松,向群辉等.地贞颗粒对“更年期”拟阴虚内热证模型大鼠的影响.中药新药与临床药理,2000;11(3):143-145
[8]范红霞,万力生,黎烈荣.更年安怡片对去卵巢大鼠脑组织中单胺类神经递质含量的影响.中医研究,1999;12(6):11-1320
[9]陈亚琼,叶雪清.血浆吲哚类神经递质与更年期综合征症状的相关分析.中华妇产科杂志,1996;31(1):41-42
[10]王大增,朱燕青,李燕萍等.更年舒治疗妇女更年期综合征的临床及实验研究.中国中西医结合杂志,1994;14(7):396-399
[11]尤劲松,胡随瑜,向群辉等.地贞颗粒对更年期拟阴虚内热证大鼠儿茶酚胺递质及促性腺激素水平的影响.湖南医科大学学报,2001;26(1):33-36
[12]易绍东,阮云军,董凤英等.雌激素对去卵巢大鼠血清一氧化氮和内皮素水平的影响.中国医师杂志,2001;3(5):339-340
[13]谈勇,许小凤,卢苏等.围绝经期综合征患者ET、NO的水平与中药替代治疗的研究.中国医刊,2001;36(12):45-47
[14]徐丙兰,钱俊华.古今中医妇科病辨证精要.人民军医出版社.2007
[15]罗元恺,等.以补肾为主治疗更年期综合征临床研究.中国医药学报,1990(2):23
[16]梅乾茵.黄绳武妇科经验集.人民卫生出版社.2006
[17]罗春艳,周世超.吴克明辨治围绝经期综合征经验撷菁.江西中医药2008年6月第6期总39卷第306期
[18]洪颖,胡志泌,许传芳.卵巢切除与更年期综合征的关系[J].中国实用妇科与产科杂志.1996,12:350-352
[1]石一复.子宫肌瘤的发病率及病因病机(J).中国医刊.2002,37(4):11-12
[2]杨燕飞等.子宫肌瘤患病年龄分布与追踪研究.[J].实用妇产科杂志.2008,24(5):299
[3]Parkin DM,Bray F,Ferlay J,et al.Global cancer statistics,2002[J].CA Cancer J Clin,2005,55:74-108.
[4]臧荣余.卵巢癌预防研究在欧美.肿瘤学杂志.2006,2(12):107
[5]因良性病变行子宫切除时保留卵巢[英]/Parker WH…//Obs tet Gynecol.-2005,106(2).-219-226
[6]Kauff N,Satagopian J,Robson M,et al.Risk educingsalpingo-oophorectomy in women with a BRCA1 or BR-CA2mutation[J].N Engl J Med,2002,346:1609-1615.
[7]蒙晓玲.子宫及卵巢切除术对女性内分泌和性功能的影响.医学与哲学(临床决策论坛版).2006,4(27)
[8]吴桂珠,郑秀,王金华.子宫肌瘤867例临床分析.福建医药杂志.2004,6(26):142-143
[9]康德英,张国翔,郭伟.子宫肌瘤子宫切除时卵巢去留问题的探讨.山东医药.2002,20(42):54-55
[10]李丹,丁国莉.妇科手术对卵巢保留问题的临床与病理分析.黑龙江医学.2002,3(26):169
[11]薛梅,邹吟.子宫切除术中卵巢处理方式对内分泌的近期影响.上海第二医科大学学报.2003,1(28)
[12]王颖梅,薛凤霞.预防性卵巢切除的热点问题.现代妇产科进展.2005.14(3):235-238
[13]Berek Jonathan S.NOVAK妇科学(M).北京:人民卫生出版社,2005:512
[14]Steven A,Boyd J.Current understanding of the epidemiology and clinical implication of BRCA2 mutations for ovarian cancer.Curr Opin Ostet Gynecol,2002,14:19-26
[15]郑萍,王淑兰,高晓秋,等.子宫切除术后对卵巢功能的影响.首都医大学报,2000,12(4):335-337
[16]蔡桂茹.关于预防性卵巢切除的问题,国外医学计划生育妇产科学分册,1975,(2):105.
[17]蔡裴西·子宫良性病变手术时卵巢的去留问题[J]·中华妇产科杂志,1984,19(2):16·
[18]陈丹光·卵巢切除后内分泌和生化学变化[J]·中华妇产科杂志,1987,22(5):281·
[19]林仲秋·卵巢良性肿瘤剔除术的评价[J]·中华妇产科杂志,1989,24(4):228·
[20]蒋味根·妇科良性肿瘤手术时卵巢去留问题[J]·实用妇科与产科杂志,1987,3(5):229·
[21]焦书竹·子宫肌瘤的子宫切除术式与卵巢去留的探讨[J]·中华妇产科杂志,1984,19(2):71·
[22]张爱红,王聚宏.子宫切除术有关问题的商榷.中国厂矿医学.2 002年,5(15)
[23]姜静,张川利,王毅.子宫切除术后卵巢功能变化的观察.实用妇产科杂志,2005,21(10):630
[24]SiddleN,SarrleP,WhiteheadM.The effects of hysterectomy on the age at ovarian failure:identification of a Subgroup of wonmen with premature loss of ovarian function.Feritl steril,1987,47(1):94
[25]艾浩,薛晓鸥,温玉库等.绝经前单纯子宫切除对卵巢功能的研究.中国妇产科临床杂志,2004,5(6):413-415。
[26]邓君碧.卵巢切除后的内分泌变化.实用妇产科杂志,1992,260-262
[27]史金凤,尹伶,濮德敏.子宫肌瘤病因及发病机理研究进展
[28]洪颖,胡志泌,许传芳.卵巢切除与更年期综合征的关系[J].中国实用妇科与产科杂志.1996,12:350-352
[29]曹美良.不同术式切除子宫,卵巢对内分泌及更年期症状的影响.实用妇产科进展,2000,16(2):79