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目的:观察腹腔镜联合莪棱内异汤保留灌肠治疗子宫内膜异位症(EMs)不孕的临床疗效及对患者血清基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)的影响。方法:将85例EMs患者随机分为A、B、C3组,A组30例采用腹腔镜手术联合莪棱内异汤保留灌肠治疗,B组28例采用腹腔镜手术配合米非司酮片口服治疗,C组27例单纯行腹腔镜手术治疗。观察3组治疗前后中医证候积分及血清MMP-9、TIMP-1水平的变化,比较3组术后3、6、12月后的妊娠率。结果:治疗后,A、B2组的中医证候积分均较治疗前下降(P<0.05),A、B2组治疗前后中医证候积分的差值均大于C组(P<0.05)。术后3月,A、C2组的妊娠率均高于B组(P<0.05)。术后6月和术后12月,A、B2组的妊娠率均高于C组(P<0.05)。治疗后,3组MMP-9水平及MMP-9/TIMP-1值均较治疗前下降(P<0.05),A、B2组TIMP-1水平均较治疗前升高(P<0.05)。A、B组2组MMP-9水平及MMP-9/TIMP-1值均较C组下降更明显(P<0.05),TIMP-1水平均较C组上升更明显(P<0.05)。结论:腹腔镜联合莪棱内异汤保留灌肠可有效改善EMs不孕患者的临床症状,使MMP-9和TIMP-1趋于平衡,提高临床妊娠率。
Objective: To observe the clinical efficacy of laparoscopy combined with Curcumae Recto-retention enema in the treatment of infertility with endometriosis (EMs) and its effect on the serum level of matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase inhibitor- (TIMP-1) effects. Methods: A total of 85 patients with EMs were randomly divided into A, B, and C3 groups. A group of 30 patients were treated with laparoscopy combined with Curcumae Yisutang retention enema. Group B, 28 patients underwent laparoscopic operation combined with mifepristone tablets Treatment, C group of 27 cases of simple laparoscopic surgery. The changes of TCM syndrome scores and serum MMP-9 and TIMP-1 levels before and after treatment were observed in 3 groups. The pregnancy rates of 3, 6 and 12 months after operation were compared between the three groups. Results: After treatment, the scores of TCM syndromes in groups A and B2 were lower than those before treatment (P <0.05). The difference of TCM syndrome scores in groups A and B2 before and after treatment were greater than those in group C (P <0.05). After 3 months, the pregnancy rates in groups A and C2 were higher than those in group B (P <0.05). The pregnancy rates in groups A and B2 were significantly higher than those in group C at 6 months and 12 months after operation (P <0.05). After treatment, the levels of MMP-9 and MMP-9 / TIMP-1 in three groups were significantly lower than those before treatment (P <0.05). The levels of TIMP-1 in groups A and B2 were higher than those before treatment (P <0.05). The levels of MMP-9 and MMP-9 / TIMP-1 in group A and group B were significantly lower than those in group C (P <0.05), while the levels of TIMP-1 in group A and group B were more significant than those in group C (P <0.05). Conclusion: Laparoscopy combined with Curcuma Curcuma Indirect Decoction retention enema can effectively improve the clinical symptoms of infertility patients with EMs, MMP-9 and TIMP-1 tend to balance and improve the clinical pregnancy rate.