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Article(id=1322927492708827349, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.07.019, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340093066, onlineDateStr=2026-10-30, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340093066, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340093066, creator=13701087609, updateTime=1793340093066, updator=13701087609, issue=Issue{id=1322925862630339452, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='7', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1752076800000', pubDateStr='2025-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339704424, creator='13701087609', updateTime=1793340532184, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929334587105328, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929334587105329, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=86, endPage=89, ext={EN=ArticleExt(id=1322927492914348246, articleId=1322927492708827349, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Therapeutic Effect of Modified Shaofu Zhuyu Decoction（少腹逐瘀汤加减）Combined with Deinorgestrel in Treatment of Postoperative Pain in Laparoscopic Surgery for Ovarian Endometriosis, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the clinical efficacy of Modified Shaofu Zhuyu Decoction（少腹逐瘀汤加减）combined with progesterone in the treatment of postoperative pain in laparoscopic surgery for ovarian endometriosis.

Method

A total of 100 patients with ovarian endometriosis who were treated in the obstetrics and gynecology department of the hospital from January 2022 to December 2023 were selected. The above patients were randomly divided into two groups，with 50 cases in each group. The control group was treated with progesterone，while the observation group was treated with Modified Shaofu Zhuyu Decoction in addition to that of the control group. The clinical efficacy，pain level，adverse reactions as well as changes in ovarian reserve function and hormone levels were compared before and after treatment between two groups.

Result

The effective rate of the observation group（94.00%，47/50）was significantly better than that of the control group（80.00%，40/50），and the difference was statistically significant（P<0.05）. After 3 months of intervention and 6 months of follow-up，the visual analog scale（VAS）scores of dysmenorrhea，sexual intercourse pain and chronic pelvic pain in the observation group were significantly lower than those in the control group（P<0.01）. After intervention，the levels of follicle stimulating hormone（FSH），luteinizing hormone（LH）and estradiol（E2）in the observation group were significantly reduced compared to those in the control group（P<0.01）. After intervention，the ovarian volume of the observation group was significantly decreased compared to that of the control group，while the AFC number significantly increased（P<0.01）. The main adverse reactions of all patients during the intervention process were hot flashes，excessive sweating，headache and irregular vaginal bleeding，but the symptoms were mild. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

The combination of Shaofu Zhuyu Decoction and deinorgestrel has good clinical efficacy in the treatment of postoperative pain in patients with ovarian endometriosis undergoing laparoscopic surgery. It can significantly alleviate the clinical symptoms such as dysmenorrhea，sexual intercourse pain and chronic pelvic pain，regulate the hormone levels and improve the ovarian reserve function，making it suitable for clinical application.

, authors=Li LIU, Wei LU, Hongrong YANG, Juan HUANG, authorsList=Li LIU, Wei LU, Hongrong YANG, Juan HUANG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927495963607264, articleId=1322927492708827349, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛疗效分析, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

观察少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛临床疗效。

方法

选择2022年1月—2023年12月于医院妇产科治疗的100例卵巢子宫内膜异位症患者，将上述患者随机分为两组，每组50例，对照组患者予以地诺孕酮治疗，观察组在对照组基础上联合少腹逐瘀汤加减治疗。比较两组患者的临床疗效、疼痛程度和不良反应情况，以及治疗前后卵巢储备功能和激素水平变化。

结果

观察组患者的有效率（94.00%，47/50）显著优于对照组（80.00%，40/50），差异具有统计学意义（P<0.05）。干预后3个月及随访6个月，观察组患者的痛经、性交痛以及慢性盆腔痛的VAS评分水平相较于对照组均明显下降（P<0.01）。干预完成后，观察组患者卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平相较于对照组均明显降低（P<0.01）。观察组患者的卵巢体积相较于对照组均明显下降，而窦卵泡计数（AFC）则显著升高（P<0.01）。干预过程中所有患者的主要不良反应有潮热、汗多、头痛、阴道不规则出血等，但症状轻微，两组患者的不良反应发生率差异无统计学意义（P>0.05）。

结论

少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛具有良好的临床疗效，能够明显减轻患者痛经、性交痛、慢性盆腔痛等临床症状，调节激素水平并提高卵巢储备功能，适宜临床应用。

, authors=刘莉, 卢维, 杨洪容, 黄娟, authorsList=刘莉, 卢维, 杨洪容, 黄娟, authorCompany=null, correspAuthors=null, authorNote=

刘莉（1978-），女，四川德阳人，主治医师，学士，研究方向：宫颈疾病、生殖、内分泌、计划生育相关。

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刘莉（1978-），女，四川德阳人，主治医师，学士，研究方向：宫颈疾病、生殖、内分泌、计划生育相关。

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刘莉（1978-），女，四川德阳人，主治医师，学士，研究方向：宫颈疾病、生殖、内分泌、计划生育相关。

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组别例数年龄/（岁）经期/（d）病程/（月）
对照组5033.57±3.526.27±1.2615.87±4.78
观察组5034.01±5.135.92±1.6515.16±4.83
t/χ2值0.6230.6720.417
P值0.4720.4850.549
), ArticleFig(id=1322927498169811203, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=CN, label=表1, caption=

两组卵巢子宫内膜异位症患者一般资料比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁）经期/（d）病程/（月）
对照组5033.57±3.526.27±1.2615.87±4.78
观察组5034.01±5.135.92±1.6515.16±4.83
t/χ2值0.6230.6720.417
P值0.4720.4850.549
), ArticleFig(id=1322927498236920068, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
对照组5023（46.00）17（34.00）10（20.00）40（80.00）
观察组5028（56.00）19（38.00）3（6.00）47（94.00）
χ2值4.128
P值0.047
), ArticleFig(id=1322927498295640325, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=CN, label=表2, caption=

两组卵巢子宫内膜异位症患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
对照组5023（46.00）17（34.00）10（20.00）40（80.00）
观察组5028（56.00）19（38.00）3（6.00）47（94.00）
χ2值4.128
P值0.047
), ArticleFig(id=1322927498362749190, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痛经性交痛慢性盆腔痛
干预前干预3个月后随访6个月干预前干预3个月后随访6个月干预前干预3个月后随访6个月
对照组508.27±2.585.48±1.373.45±1.957.13±2.794.25±1.692.25±1.157.69±2.394.78±2.091.97±1.72
观察组508.85±2.644.23±1.122.27±1.486.97±2.573.06±1.951.06±0.937.87±2.713.97±1.371.03±1.06
t值0.8934.5675.349-1.0625.0395.935-0.9656.9814.593
P值0.1620.0000.0000.0980.0000.0000.1760.0000.000
), ArticleFig(id=1322927498488578311, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=CN, label=表3, caption=

两组卵巢子宫内膜异位症患者疼痛程度比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痛经性交痛慢性盆腔痛
干预前干预3个月后随访6个月干预前干预3个月后随访6个月干预前干预3个月后随访6个月
对照组508.27±2.585.48±1.373.45±1.957.13±2.794.25±1.692.25±1.157.69±2.394.78±2.091.97±1.72
观察组508.85±2.644.23±1.122.27±1.486.97±2.573.06±1.951.06±0.937.87±2.713.97±1.371.03±1.06
t值0.8934.5675.349-1.0625.0395.935-0.9656.9814.593
P值0.1620.0000.0000.0980.0000.0000.1760.0000.000
), ArticleFig(id=1322927498568270088, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数FSH/（U/L）LH/（U/L）E2/（ng/mL）
干预前干预后干预前干预后干预前干预后
对照组506.87±1.964.14±1.6712.09±3.029.23±2.57132.64±10.97101.73±12.72
观察组506.18±1.383.57±1.3512.65±2.958.43±2.27129.71±11.4689.85±13.46
t值0.2434.353-0.2134.845-0.3648.042
P值0.8150.0010.8370.0000.7090.000
), ArticleFig(id=1322927498639573257, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=CN, label=表4, caption=

两组卵巢子宫内膜异位症患者激素水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数FSH/（U/L）LH/（U/L）E2/（ng/mL）
干预前干预后干预前干预后干预前干预后
对照组506.87±1.964.14±1.6712.09±3.029.23±2.57132.64±10.97101.73±12.72
观察组506.18±1.383.57±1.3512.65±2.958.43±2.27129.71±11.4689.85±13.46
t值0.2434.353-0.2134.845-0.3648.042
P值0.8150.0010.8370.0000.7090.000
), ArticleFig(id=1322927500321489163, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数卵巢体积/（cm3）AFC/（个）
干预前干预后干预前干预后
对照组506.25±1.714.75±1.378.15±1.584.45±1.10
观察组506.56±1.094.05±0.798.70±1.385.20±0.97
t值0.1544.0830.864-4.266
P值0.8710.0000.1090.000
), ArticleFig(id=1322927500426346764, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=CN, label=表5, caption=

两组卵巢子宫内膜异位症患者卵巢储备功能比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数卵巢体积/（cm3）AFC/（个）
干预前干预后干预前干预后
对照组506.25±1.714.75±1.378.15±1.584.45±1.10
观察组506.56±1.094.05±0.798.70±1.385.20±0.97
t值0.1544.0830.864-4.266
P值0.8710.0000.1090.000
), ArticleFig(id=1322927500506038541, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927492708827349, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数潮热汗多头痛阴道不规则出血总发生
对照组501（2.00）2（4.00）1（2.00）1（2.00）5（10.00）
观察组502（4.00）3（6.00）0（0.00）1（2.00）6（12.00）
χ2值0.205
P值0.653
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两组卵巢子宫内膜异位症患者不良反应比较

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组别例数潮热汗多头痛阴道不规则出血总发生
对照组501（2.00）2（4.00）1（2.00）1（2.00）5（10.00）
观察组502（4.00）3（6.00）0（0.00）1（2.00）6（12.00）
χ2值0.205
P值0.653
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少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛疗效分析
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刘莉 , 卢维 , 杨洪容 , 黄娟
中华中医药学刊 | 国家项目点击 2025,43(7): 86-89
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中华中医药学刊 |国家项目点击 2025 , 43 (7) : 86 -89
少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛疗效分析
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刘莉, 卢维, 杨洪容, 黄娟
作者信息
  • 德阳市人民医院，四川 德阳 618000
作者简介:

刘莉（1978-），女，四川德阳人，主治医师，学士，研究方向：宫颈疾病、生殖、内分泌、计划生育相关。

Therapeutic Effect of Modified Shaofu Zhuyu Decoction（少腹逐瘀汤加减）Combined with Deinorgestrel in Treatment of Postoperative Pain in Laparoscopic Surgery for Ovarian Endometriosis
Li LIU, Wei LU, Hongrong YANG, Juan HUANG
Affiliations
  • Gynecology Department of Deyang People's Hospital，Deyang 618000，Sichuan，China
出版时间: 2025-07-10 doi: 10.13193/j.issn.1673-7717.2025.07.019
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摘要
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目的

观察少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛临床疗效。

方法

选择2022年1月—2023年12月于医院妇产科治疗的100例卵巢子宫内膜异位症患者，将上述患者随机分为两组，每组50例，对照组患者予以地诺孕酮治疗，观察组在对照组基础上联合少腹逐瘀汤加减治疗。比较两组患者的临床疗效、疼痛程度和不良反应情况，以及治疗前后卵巢储备功能和激素水平变化。

结果

观察组患者的有效率（94.00%，47/50）显著优于对照组（80.00%，40/50），差异具有统计学意义（P<0.05）。干预后3个月及随访6个月，观察组患者的痛经、性交痛以及慢性盆腔痛的VAS评分水平相较于对照组均明显下降（P<0.01）。干预完成后，观察组患者卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平相较于对照组均明显降低（P<0.01）。观察组患者的卵巢体积相较于对照组均明显下降，而窦卵泡计数（AFC）则显著升高（P<0.01）。干预过程中所有患者的主要不良反应有潮热、汗多、头痛、阴道不规则出血等，但症状轻微，两组患者的不良反应发生率差异无统计学意义（P>0.05）。

结论

少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛具有良好的临床疗效，能够明显减轻患者痛经、性交痛、慢性盆腔痛等临床症状，调节激素水平并提高卵巢储备功能，适宜临床应用。

卵巢子宫内膜异位症  /  腹腔镜术后  /  少腹逐瘀汤  /  地诺孕酮  /  卵巢储备功能
Objective

To observe the clinical efficacy of Modified Shaofu Zhuyu Decoction（少腹逐瘀汤加减）combined with progesterone in the treatment of postoperative pain in laparoscopic surgery for ovarian endometriosis.

Method

A total of 100 patients with ovarian endometriosis who were treated in the obstetrics and gynecology department of the hospital from January 2022 to December 2023 were selected. The above patients were randomly divided into two groups，with 50 cases in each group. The control group was treated with progesterone，while the observation group was treated with Modified Shaofu Zhuyu Decoction in addition to that of the control group. The clinical efficacy，pain level，adverse reactions as well as changes in ovarian reserve function and hormone levels were compared before and after treatment between two groups.

Result

The effective rate of the observation group（94.00%，47/50）was significantly better than that of the control group（80.00%，40/50），and the difference was statistically significant（P<0.05）. After 3 months of intervention and 6 months of follow-up，the visual analog scale（VAS）scores of dysmenorrhea，sexual intercourse pain and chronic pelvic pain in the observation group were significantly lower than those in the control group（P<0.01）. After intervention，the levels of follicle stimulating hormone（FSH），luteinizing hormone（LH）and estradiol（E2）in the observation group were significantly reduced compared to those in the control group（P<0.01）. After intervention，the ovarian volume of the observation group was significantly decreased compared to that of the control group，while the AFC number significantly increased（P<0.01）. The main adverse reactions of all patients during the intervention process were hot flashes，excessive sweating，headache and irregular vaginal bleeding，but the symptoms were mild. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

The combination of Shaofu Zhuyu Decoction and deinorgestrel has good clinical efficacy in the treatment of postoperative pain in patients with ovarian endometriosis undergoing laparoscopic surgery. It can significantly alleviate the clinical symptoms such as dysmenorrhea，sexual intercourse pain and chronic pelvic pain，regulate the hormone levels and improve the ovarian reserve function，making it suitable for clinical application.

ovarian endometriosis  /  postoperative laparoscopic surgery  /  Shaofu Zhuyu Decoction（少腹逐瘀汤）  /  dienogest  /  ovarian reserve function
刘莉, 卢维, 杨洪容, 黄娟. 少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛疗效分析. 中华中医药学刊, 2025 , 43 (7) : 86 -89 . DOI: 10.13193/j.issn.1673-7717.2025.07.019
Li LIU, Wei LU, Hongrong YANG, Juan HUANG. Therapeutic Effect of Modified Shaofu Zhuyu Decoction（少腹逐瘀汤加减）Combined with Deinorgestrel in Treatment of Postoperative Pain in Laparoscopic Surgery for Ovarian Endometriosis[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (7) : 86 -89 . DOI: 10.13193/j.issn.1673-7717.2025.07.019
正文
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子宫内膜异位症是女性常见的慢性疾病，指子宫内膜样组织出现在子宫腔及肌层以外的部位，常见于卵巢、腹膜、宫骶韧带等处。该病虽属良性，但具有恶性肿瘤样的浸润性、生长性及高复发特征，可引发慢性盆腔痛、痛经及不孕等问题[1-2]。流行病学数据显示，全球约1.9亿育龄女性受其影响，其中30%～50%伴发不孕症[3-6]。目前临床治疗以腹腔镜手术及药物干预为主。手术虽可清除病灶，改善解剖结构，但术后复发率较高，且多次手术可能损伤卵巢组织，影响其功能。此外，由于该病属激素依赖性疾病，术后仍易在体内雌激素作用下复发。因此，术后常需配合药物巩固疗效。地诺孕酮作为新型孕激素，能抑制异位内膜增生，减轻疼痛，改善卵巢功能，广泛用于术后辅助治疗[7-8]。
在中医理论中，子宫内膜异位症多属“痛经”“癥瘕”“不孕”等范畴，病机以瘀血内阻、气滞血瘀为主。中医治疗注重整体调理、标本兼顾，尤其在术后调养及复发防控中显示出独特优势。少腹逐瘀汤出自《医林改错》，具有活血化瘀、温经止痛之效，常用于寒凝血瘀所致之少腹冷痛、痛经、癥瘕等证，配伍灵活，可随证加减[9]。现代药理研究表明，少腹逐瘀汤能改善子宫内膜异位灶的微循环、调节激素水平、抑制炎症因子表达，并有助于缓解慢性盆腔痛等症状[10]。因此，在地诺孕酮治疗基础上联合应用少腹逐瘀汤，可能在缓解术后疼痛、改善卵巢功能及预防复发方面发挥协同增效作用，具有良好的临床应用价值。
1　临床资料
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1.1　一般资料
本研究经过德阳市人民医院伦理委员会审核批准。选择2022年1月—2023年12月于我院妇产科治疗的100例卵巢子宫内膜异位症患者，将上述患者随机分为两组，每组50例，对照组患者予以地诺孕酮治疗，观察组在对照组基础上联合少腹逐瘀汤加减治疗。两组患者临床资料的差异无统计学意义（P>0.05）。见表1。
1.2　纳入标准
①卵巢子宫内膜异位症的诊断标准参照《妇产科学（第9版）》，且经超声确诊，均接受腹腔镜术治疗；②22岁≤年龄≤40岁，已婚有性生活；③美国生育学会内异症分期标准（R-AFS）属于Ⅱ～Ⅳ期；④首次发病；⑤既往月经周期规律，意识清晰、依从性好者；⑥患者或家属对研究内容知情同意。
1.3　排除标准
①生殖系统存在器质性病变者；②存在子宫创伤史或者手术史者；③近1个月内服用激素类药物者；④过敏体质，对本研究所用药物过敏者；⑤合并有心肺、脑血管、肝肾、造血系统严重原发病者；⑥药物滥用、烟酒成瘾或吸毒者；⑦合并精神分裂症等严重精神疾病者；⑧正在参加影响本研究结果评价的其他临床试验者。
2　方法
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2.1　对照组
患者腹腔镜术后，月经复潮2～3 d，予以口服地诺孕素片（德国拜耳医药公司，H20180090），2 mg/次，1次/d，4周为1个疗程，共治疗3个疗程。
2.2　观察组
在对照组基础上联合少腹逐瘀汤（小茴香15 g，延胡索15 g，赤芍15 g，官桂15 g，炒蒲黄15 g，没药10 g，川芎10 g，醋五灵脂10 g，干姜9 g，当归9 g），上药水煎400 mL，2次/d，1剂/d。共治疗3个月经周期。
3　观察指标
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3.1　临床疗效
总有效率＝显效率＋有效率，其中患者症状及体征消失，实验室指标恢复正常，且超声检查显示盆腔内无包块，为显效；患者症状及体征明显减轻，实验室指标显著改善，且超声检查显示盆腔肿块明显缩小，为有效；患者症状、体征及实验室指标未见改善，且超声检查盆腔包块无缩小，甚至增大，为无效。
3.2　疼痛程度
采用视觉模拟评分法（VAS）评分在干预前后不同时间点对两组患者痛经、性交痛、慢性盆腔痛的疼痛程度进行主观打分，总分0～10分，分值与疼痛程度呈正相关，比较两组病人在不同时间点的疼痛程度有无差异。
3.3　激素水平
于患者干预前、术后3个月抽取空腹外周静脉血5 mL，采用全自动生化检测仪检测血清卵泡刺激素（FSH）、黄体生成素（LH）以及雌二醇（E2）水平。
3.4　卵巢储备功能
通过超声检测数据计算干预前后卵巢体积，应用超声波检测窦卵泡计数（AFC）。
3.5　不良反应比较
观察潮热、汗多、头痛、阴道不规则出血等发生情况。
4　统计学方法
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采用SPSS 25.0软件对数据进行统计分析，以平均值±标准差（mean±SD）表示计量资料，采用独立样本t检验来评估疼痛程度、治疗前后卵巢储备功能和激素水平变化组间差异。临床疗效、不良反应情况以百分比（%）表示的分类数据，则使用卡方（χ2）检验对数据进行统计学差异分析。P<0.05时差异具有统计学意义。
5　结果
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5.1　临床疗效比较
观察组患者的有效率（80.00%）显著优于对照组的有效率（94.00%），差异具有统计学意义（P<0.05）。见表2。
5.2　疼痛程度比较
干预前两组患者的疼痛程度差异无统计学意义（P>0.05）；干预后3个月及随访6个月，观察组患者的痛经、性交痛以及慢性盆腔痛的VAS评分水平相较于对照组均明显下降（P<0.01）。见表3。
5.3　激素水平比较
干预完成后，观察组患者FSH、LH、E2水平相较于对照组均明显降低（P<0.01）。见表4。
5.4　卵巢储备功能比较
干预前两组患者的卵巢体积和AFC个数差异无统计学意义（P>0.05）；干预完成后，观察组患者的卵巢体积相较于对照组均明显下降，AFC个数则显著升高（P<0.01）。见表5。
5.5　不良反应比较
干预过程中所有患者的主要不良反应有潮热、汗多、头痛、阴道不规则出血等，但症状轻微，两组患者的不良反应发生率差异无统计学意义（P>0.05）。见表6。
6　讨论
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子宫内膜异位症虽是一种良性疾病，但属于妇科多发病，好发于25～45岁育龄女性群体。该病是由于子宫体以外的脏器或位置出现子宫内膜腺体，患者主要临床表现为疼痛、包块和不孕，疼痛形式包括性交痛、慢性盆腔痛以及经期前后腹痛等，继发性痛经并呈进行性加重为其临床特征[11-13]。目前子宫内膜异位症的机制尚不清楚，多种病因机制论以Sampson的经血逆流假说占据了核心位置，该病作为雌激素依赖性疾病，对具有生育需求的患者造成严重困扰[14-15]。研究表明，异位内膜导致的阶段性出血、外周组织纤维化造成的异位结节是子宫内膜异位症的主要病理变化，异位内膜使胚胎植入能力下降，子宫内膜病变、外周组织纤维化造成解剖障碍，均增加了妇科疾病及不孕的风险[16-18]。
子宫内膜异位症归属于中医学中“癥瘕”“不孕”“妇人腹痛”“痛经”等范畴，认为其关键病机为“血瘀”，寒凝血瘀证为最常见的临床证型。女子属阴，以血为本、为用，瘀血阻滞于胞宫、下焦，阳气无法温煦胞脉，气血运行不畅，胞宫气血受阻，胞脉不通则痛，瘀血长期停滞，久病入络，加重气滞血瘀，至“不荣则痛”[19-20]。故治之应以活血祛瘀、温经散寒止痛为主要原则。少腹逐瘀汤出自林清任之《医林改错》，由小茴香、延胡索、赤芍、官桂、炒蒲黄，没药、川芎、醋五灵脂、干姜、当归等药物组成。方中当归[21]、川芎[22]、赤芍[23]活血行气、养血调经，共为君药；炒蒲黄[24]活血祛瘀、五灵脂[25]通络止痛，为臣药；小茴香[26]、干姜[27]、官桂[28]同为佐药，具有散寒通阳的功效，并可引诸药直达少腹；延胡索[29]、没药[30]为使药，可活血化瘀、消肿定痛。全方共奏化瘀散结、调经止痛之效。本研究结果显示，观察组患者的有效率显著优于对照组。干预前两组患者的疼痛程度无明显差异；干预后3个月及随访6个月，观察组患者的痛经、性交痛以及慢性盆腔痛的VAS评分水平相较于对照组均明显下降。干预过程中所有患者的主要不良反应有潮热、汗多、头痛、阴道不规则出血等，但症状轻微，两组患者的不良反应发生率无明显差异。现代药理学显示，少腹逐瘀汤能够调节性激素水平，改善机体微循环，松弛子宫平滑肌而抑制其自发性收缩导致的疼痛[31-32]。与本研究结果一致，干预完成后，观察组患者FSH、LH、E2水平相较于对照组均明显降低。干预前两组患者的卵巢体积和AFC个数无明显差异；干预完成后，观察组患者的卵巢体积相较于对照组均明显下降，而AFC个数则显著升高。根据“Sampson的经血逆流假说”这一理论，逆流的经血带着未凋亡的子宫内膜细胞到达异位部位，从而可能导致内膜异位症的形成。子宫内膜的增厚与内膜间质细胞的抗凋亡能力加强有关，这种抗凋亡能力的增强主要表现在凋亡抑制因子B细胞淋巴瘤-2（Bcl-2）的表达上调以及与之相关的凋亡促进因子Bcl-2相关X蛋白（Bax）的表达下调，从而降低了细胞对凋亡信号的敏感性。多项研究[33-39]提示少腹逐瘀汤可能是通过诱导这些在位内膜间质细胞的凋亡，使子宫内膜的细胞状态恢复正常。这种诱导凋亡的作用不仅有助于治疗内膜异位症，还可能防止疾病的复发。因此，少腹逐瘀汤可能通过诱导这些位内膜间质细胞的凋亡，使子宫内膜的细胞状态恢复正常治疗改善、干预、预防子宫内膜异位的作用。这为内膜异位症的管理提供了新的治疗策略，尤其是对于那些倾向于使用整合医学方法的患者。
本研究结果表明，少腹逐瘀汤加减联合地诺孕酮治疗卵巢子宫内膜异位症腹腔镜术后疼痛具有良好的改善作用，能够明显减轻患者痛经、性交痛、慢性盆腔痛等临床症状，并对患者激素水平有调节改善，提高了患者卵巢储备功能，但本次研究为单中心较小样本研究，未来考虑长期跟踪评估少腹逐瘀汤的疗效以及安全性。
基金
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  • 国家“十二五”科技支撑项目(2011BAI11B01)
  • 四川省科技厅科研项目(2023JDKP0041)
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2025年第43卷第7期
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doi: 10.13193/j.issn.1673-7717.2025.07.019
  • 首发时间：2026-10-30
  • 出版时间：2025-07-10
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国家“十二五”科技支撑项目(2011BAI11B01)
四川省科技厅科研项目(2023JDKP0041)
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    德阳市人民医院，四川 德阳 618000
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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