Endometriosis is a common and frequently-occurring disease in gynecology. It refers to a disease in which the endometrium with growth function appears in other parts of the body outside the mucosa covered by the uterine cavity, causing a series of symptoms such as dysmenorrhea, irregular menstruation, infertility, pelvic mass and sexual pain. In particular, dysmenorrhea caused by endometriosis is getting worse, which seriously affects women's physical and mental health. From July 5438, 2006 to June 2003, our hospital used traditional Chinese medicine to treat endometriosis dysmenorrhea and achieved satisfactory results. The report is as follows.
Clinical data of 1
1. 1 Diagnostic criteria refer to the Guiding Principles for Clinical Research of New Chinese Medicine issued by the Ministry of Health: (1) Progressive dysmenorrhea; (2) Abdominal fever, lumbosacral discomfort and progressive aggravation during menstruation; (3) Periodic rectal irritation, with progressive aggravation; (4) The posterior fornix uterosacral ligament or uterine isthmus touches the painful nodule; (5) The adnexal conglutination mass is accompanied by cystic nodule, and the fallopian tube is unobstructed; (6) The size of adnexal masses changes obviously before and after menstruation. If there is 1 in (1) ~ (3) and 1 in (4) ~ (6), it can be diagnosed as endometriosis.
1.2 dysmenorrhea score standard menstrual period and abdominal pain before and after 5 points (basic score), unbearable abdominal pain 1 point, obvious abdominal pain 0.5 points, fidgeting 1 point, shock 2 points; Pale face 0.5, cold sweat 1, with general analgesic measures, temporarily relieved pain 0.5, lumbosacral pain 0.5, nausea and vomiting 0.5, anal dilatation 0.5, defecation frequency 0.5, 1 day pain 0.5, and pain increased by 65,438+every time. The score of severe dysmenorrhea is above 14, the score of moderate dysmenorrhea is 8 ~ 13.5, and the score of mild dysmenorrhea is below 8.
1.3 TCM syndrome differentiation of qi stagnation and blood stasis: abdominal distension and pain during premenstrual and menstrual period, refusal to press, less menstrual flow, poor operation, dark purple color, lump, temporary relief of pain under the lump, premenstrual breast swelling and pain, chest tightness, dark purple tongue, petechiae and pulse string.
1.4 general data: all the cases in this group were outpatients, and * *116 cases were married. They were randomly divided into treatment group (58 cases, aged 26-43 years, with a course of 1.5-8 years). Mild dysmenorrhea 16 cases, moderate dysmenorrhea in 37 cases and severe dysmenorrhea in 5 cases, among which 3 cases of mild dysmenorrhea gave up because they could not stand the taste of traditional Chinese medicine; 58 cases in the control group, aged 25-45 years, had a course of 2-7 years, including 65,438 04 cases of mild dysmenorrhea, 38 cases of moderate dysmenorrhea and 6 cases of severe dysmenorrhea. There was no significant difference between the two groups (P & gt0.05), which was comparable.
2 treatment methods
2. 1 The treatment group was treated with Quyu Tongjing Decoction, a prescription approved by the hospital. Prescription: Rhizoma Sparganii 5g, Rhizoma Curcumae 5g, Radix Salviae Miltiorrhizae 15g, Radix Curcumae 15g, Radix Paeoniae Rubra 15g, Endothelium Corneum Gigeriae Galli 10g, Bulbus Fritillariae Thunbergii 15g, Carapax Trionycis 15g, and Radix Angelicae Sinensis. Using a decocting machine, each pair of Chinese medicines is 200ml, and each pair 100 ml is 1 bag, twice a day, each time 100ml, and taken orally twice in the morning and evening, not during menstrual period. Judge the curative effect after three months.
2.2 The control group took danazol (Shanghai Hualian Pharmaceutical Company, batch number: 20020 130) capsules 200mg×30 capsules twice a day, and took the medicine on the fifth day of menstruation. When amenorrhea occurs, the dose is reduced to 200mg per day, which is the maintenance amount. Continuous treatment for 3 months is 1 course of treatment, and the curative effect is judged after the course of treatment.
3 efficacy standards and results
3. 1 Treatment criteria refer to the treatment evaluation criteria of dysmenorrhea in the Guiding Principles for Clinical Research of New Chinese Medicine. Recovery: Symptoms such as menstrual abdominal pain disappeared after taking the medicine, and the score was 0, and there was no recurrence for three consecutive menstrual cycles; The effect is remarkable: after treatment, the score drops below 1/2 before treatment, abdominal pain is obviously relieved, other symptoms are improved, and those who refuse to take painkillers can continue to work; Effective: after treatment, the score decreased to 65,438+0/2 ~ 3/4 before treatment, abdominal pain was relieved, other symptoms were improved, and patients could continue to work after taking painkillers; Ineffective: Abdominal pain and symptoms have not improved. Cure+effective+effective is effective.
3.2 Results See Table 1 for the comparison of curative effects between the two groups.
Table 1 Comparison of curative effects between two groups (omitted)
The total effective rate of the two groups was 89.65438 0% in the treatment group and 74.65438 0% in the control group, the difference was statistically significant (P < 0.05), and the treatment group was superior to the control group. And in the course of treatment, the improvement of abdominal pain and breast pain in the Chinese medicine group is obviously better than that in the control group.
4 discussion
Dysmenorrhea due to endometriosis is a common and frequently-occurring disease in gynecology. Because of its high incidence, it seriously affects women's health, work efficiency and quality of life. The western medicine pathology of endometriosis dysmenorrhea is endometriosis, and periodic bleeding occurs under the action of sex hormones. Because blood does not follow the meridians, it cannot be excreted normally and accumulates in the lower jiao, which is called "menstrual blood" in Chinese medicine, that is, blood stasis. The main signs of most patients are purple and dark tongue coating or ecchymosis, which accords with the diagnosis of blood stasis in traditional Chinese medicine. Traditional Chinese medicine believes that blood stasis blocks the lower jiao, which leads to poor qi movement, and "impassability leads to pain" leading to dysmenorrhea. It can be seen that blood stasis is the key to the symptoms and signs of dysmenorrhea in endometriosis. Dysmenorrhea is due to blood stasis, dysfunction of chong and ren meridians, obstruction of meridians, obstruction of vagina and obstruction of chong and ren meridians. Blood stasis is the essence of dysmenorrhea in endometriosis. Traditional Chinese medicine believes that "Qi is the handsome of blood, and blood is the mother of Qi". Blood stasis affects the operation of Qi, leading to qi stagnation and blood stasis, and the operation of meridians and qi-moving machines is limited. Under the guidance of this academic thought, we can eliminate blood stasis. Regulate qi and relieve pain, and form a prescription for removing blood stasis and relieving pain. In the prescription, Rhizoma Sparganii and Rhizoma Curcumae break blood, promote qi circulation, remove blood stasis and dissipate stagnation. ; Salvia miltiorrhiza breaks blood, calms and relieves pain; Paeonia lactiflora clearing heat and cooling blood, removing blood stasis and relieving pain; Does tortoise shell strengthen blood-breaking? Power; Angelica sinensis nourishes blood and promotes blood circulation, which means removing blood stasis and not forgetting to strengthen the body. The whole prescription * * * makes the blood stasis in the lower jiao dissipate, remove blood stasis and clear heat, promote qi circulation and relieve pain. Clinical observation shows that traditional Chinese medicine is superior to western medicine danazol in treating endometriosis dysmenorrhea. Traditional Chinese medicine has the functions of dredging fu-organs, regulating qi, removing blood stasis and promoting blood circulation, which makes the qi and blood of lower jiao run smoothly, especially the improvement of dysmenorrhea. It fully shows the curative effect of treating both the symptoms and the root causes of traditional Chinese medicine, which is worth popularizing.
A modern gynecological disease-endometriosis
(65438+20 February 2002)
Professor Lang Jinghe, Director of Obstetrics and Gynecology, Peking Union Medical College Hospital, China Academy of Medical Sciences, has rich experience in the diagnosis and treatment of gynecological diseases, and made a report on the application of laparoscopy in gynecology for the first time in China, which promoted the development of this advanced technology in China. (Left)
Professor Zhang Zhenyu, director of the Department of Obstetrics and Gynecology of Beichao Hospital affiliated to Capital Medical University, specializes in the diagnosis and treatment of difficult diseases such as gynecological tumors and chronic pelvic pain in women, especially endometriosis. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about endometriosis.
Moderator: Why is endometriosis called a modern gynecological disease?
Lang Jinghe: This is because the number of patients with endometriosis has increased significantly than before, and it has become a common and frequently-occurring disease among young and middle-aged women. Since 1986, the world has held a conference on endometriosis every two years. As shown in the figure, this is the medical treatment and hospitalization situation of endometriosis in Union Medical College Hospital in the last ten years, which is obviously on the rise, and the percentage of endometriosis in gynecological surgery is also on the rise.
Moderator: Is endometriosis related to the lifestyle of our modern women?
Lang Jinghe: It does matter. The increase of late marriage and late childbearing is related to the pathogenesis of endometriosis.
Moderator: What kind of disease is endometriosis?
Zhang Zhenyu: Endometriosis means that the endometrium has moved to other parts of the body, not in the uterine cavity. Endometrial cells usually grow, shed and bleed in the uterine cavity every month, resulting in menstruation. Menstrual discharge has no effect on the body and is a normal physiological phenomenon. If endometrial cells camp in other parts of the body, they will also grow, shed and bleed. If the blood cannot be discharged, it will inevitably form a lump, causing pain in these parts. So we call endometriosis a disease in which endometrial cells run out of the uterine cavity.
Moderator: How do endometrial cells get outside the uterine cavity?
Lang Jinghe: In the process of natural menstruation, some menstrual blood, including endometrial tissue, runs into the abdominal cavity. This is actually a common physiological phenomenon, called menstrual blood reflux. As shown in the figure, menstrual blood can reach the pelvic cavity and then generally melt away. In this case, endometriosis will not occur, but sometimes menstrual blood will not melt back to the pelvic cavity, where it will accumulate into lesions, thus forming endometriosis.
Moderator: What is the pathogenesis of endometriosis?
Lang Jinghe: At present, the pathogenesis of endometriosis is not very clear. The theory of menstrual blood countercurrent mentioned above is a dominant theory. At present, it is believed that the pathogenesis of endometriosis is related to heredity. In a sense, it is difficult to prevent.
Zhang Zhenyu: Endometrial cells can camp in many parts of the body except uterine cavity, including pelvic cavity, pelvic peritoneum, uterine surface, fallopian tube surface, ovarian surface, bladder and rectum. Endometriosis may form anywhere in the abdominal cavity, even reaching the trachea, nasal cavity, skin and even eyes. As shown in the figure, this is an ectopic focus in the pelvic cavity and the main part of endometriosis.
Moderator: Let's look at the situation of a patient. Patient Zhang Dajie: "In recent years, my dysmenorrhea is getting worse every year. I can't even go to work for the first day or two. I have to rest and take painkillers no matter how busy I am. It will be fine after the third day. "
Lang Jinghe: There are two major symptoms of endometriosis: 1, pain, especially dysmenorrhea, and 80% of patients with endometriosis are complicated with pain. 2, infertility, about 50% of endometriosis patients complicated with infertility.
The main manifestations of endometriosis
1, dysmenorrhea
2. Lower abdominal pain
3, low back pain
4. Sexual pain
5. Chronic pelvic pain
6. Dysuria and defecation
7. hairless
Moderator: Will unmarried women get endometriosis?
Lang Jinghe: Yes. Because as long as there is menstruation, there will be the problem of menstrual blood reflux and the possibility of endometriosis. Therefore, unmarried women should be alert to dysmenorrhea and consider the possibility of endometriosis.
Moderator: How to diagnose endometriosis?
Zhang Zhenyu: First of all, we should look at the typical manifestations of endometriosis. If yes, please ask a doctor to do a detailed pelvic examination, feel the size and position of the uterus, and see if there are any lumps and nodules in the pelvic cavity. You can also look at the location of the tumor and its relationship with the surrounding area with the help of B-ultrasound, and you can also draw blood for blood test. The above examination can lead to a preliminary diagnosis, and further diagnosis is needed. The diagnosis before diagnosis is laparoscopic examination. Laparoscopic examination can see the whole state of abdominal cavity, and can also find ectopic focus, take it out for pathological section, so as to make a diagnosis. Laparoscopy is also the gold standard for diagnosing endometriosis.
Moderator: What do you think?
Zhang Zhenyu: The treatment of endometriosis is a long and arduous process. Treatment methods include 1 and surgical treatment, which used to require surgery, but now it has been replaced by laparoscopic surgery. 2. medication.
Four basic principles for the treatment of endometriosis
1, reduce and eliminate lesions.
2. Relieve and eliminate pain
3. Improve and promote fertility.
4. Prevention and reduction of recurrence
Lang Jinghe: Laparoscopic surgery is the first choice for the treatment of endometriosis.
Moderator: Let's watch a video of laparoscopic surgery.
Lang Jinghe: This patient's dysmenorrhea is very serious. First, make a small incision in the navel and put a speculum in it. After gas injection, a large white cyst can be clearly seen. Then, the adhered part is separated and the chocolate juice is sucked (hematocele). You can clearly see the operation under the monitor. Then, the ectopic endometrial capsule can be removed, and other cysts that may exist can be removed at the same time. Finally, these cut cysts can be cut off. There are always three holes to be punched in the abdomen. You don't need to sew them, just stick them with a band-aid. The whole operation can be completed in about 30-40 minutes, with little trauma and quick recovery.
Moderator: Since surgery can be used, why should we emphasize drug treatment?
Lang Jinghe: Surgery can only cut the visible lesions as clean as possible, and it is impossible to cut all the lesions, because the lesions are very extensive, some may be under the peritoneum, and there may be new lesions. So you also need medication.
Zhang Zhenyu: Drug therapy is a systematic therapy. All endometrial cells will shrink under the action of drugs. Therefore, drug therapy is an important supplement and auxiliary means of surgical treatment.
Moderator: Can it be said that the myoma can be cured after surgical resection?
Lang Jinghe: No radical cure. Patients have a 20% chance of recurrence and should stick to medication.
Zhang Zhenyu: Drugs have some side effects. It usually takes 3 months to 6 months to take drugs, usually some drugs that inhibit ovarian function and resist estrogen. After taking drugs, you may be slightly fat, have some acne on your face, or have slight damage to your liver. Therefore, a liver function test should be done after taking the medicine for two months. If there is liver damage, some drugs should be used to protect the liver. If there is no serious reaction, patients can rest assured to take medicine.
Lang Jinghe: Endometriosis is a benign disease, not cancer. However, there is still the possibility of 1% canceration, so there are four situations that need to be prevented: 1 and the cyst is too large (greater than 10cm). 2. This kind of pain only appears in menstrual period, and then it develops into pain at any time, and it is very serious. 3. There was endometriosis before, and there was a lump after menopause. 4. The ultrasound found something abnormal. 5, blood test CA 125 value is particularly high to be vigilant.
Moderator: Ms. Lin from Heilongjiang, 35 years old. I just had surgery for endometriosis. What should we pay attention to now?
Zhang Zhenyu: The key after operation is to continue taking medicine (3-6 months) to avoid the development of the disease and consolidate the curative effect of the operation. It should also be noted that it should be reviewed one month after operation and every three months thereafter.
Moderator: Ms. Li from Beijing, 25 years old. Can endometriosis lead to ectopic pregnancy?
Zhang Zhenyu: It's possible. After endometriosis reaches the fallopian tube or pelvic cavity, it will affect the peristalsis of the fallopian tube and the normal implantation of fertilized eggs, resulting in ectopic pregnancy.
Moderator: Ms. Zhang from Beijing is 65 years old and my daughter is 30 years old. She has been suffering from endometriosis for 7 years. Sometimes her menstruation doesn't come for a year, and she has been taking Chinese medicine since she came, but it is still irregular. What should I do?
Lang Jinghe: First of all, check whether it is endometriosis. Only after the diagnosis can we treat it.
Moderator: Does Ms. Ma, a 33-year-old from Hebei Province, have anything to do with ovarian cyst and endometriosis?
Zhang Zhenyu: This is not a concept. Generally speaking, ovarian cyst is a mass in the ovary, and endometriosis can also form a mass, but it is not a tumor but a hematocele in essence, so it is necessary to distinguish between the two.
Moderator: Tel: (0 10)65296238, 85232923; Outpatient time Lang Jinghe Thursday afternoon Zhang Zhenyu Thursday afternoon.