子宫内膜异位症手术前后中医证候特征及其与复发相关性的前瞻性研究
|
摘要
目的:采用临床流行病学调查方法,进行前瞻性研究,收集EMS患者手术前后中医证候特征及可能的影响因素,探讨EMS手术前后中医证候分布、组合的规律及其与复发的可能相关性,为术后不同体质女性、疾病状况人群提供有效的预防指导方案,进一步为EMS的“未病先防”、“既病防变”及“瘥后防复”提供证候学及流行病学依据。
方法:采用半开放式的问卷调查方式,收集208例经手术治疗确诊为EMS患者,发病年龄为18～54岁,平均年龄为36.56±7.94岁,收集EMS患者中医证候特征及可能的影响因素,并进行为期1年随访,观察患者复发情况,完成术前及随访调查表。
结果:本研究共调查208例患者,1.在症状调查中,继发性痛经、渐进性加重、不孕、月经过多,经期延长、经行不畅,经血暗红色,夹血块为最常见症状,舌淡暗、舌暗红,舌有瘀点瘀斑,舌底脉络迂曲,脉弦是最常见舌脉象。2.在术前证素分布中,全部出现血瘀证,其次以气滞证、肾虚证为主,术后1周以气虚证为主,其次为血瘀证、肾虚证;术前至术后1周血瘀证、气滞证、肾虚证明显下降,而气虚证、血虚证明显增加,术后1周至术后1年肾虚证明显增加,而气虚有所下降,但仍占第一位。3.在术前证型分布中,以气滞血瘀、肾虚血瘀为主,术后1周及术后1年证型均以脾胃虚弱、脾肾两虚为主;术后1周脾胃虚弱、气血亏虚、脾肾两虚证较术前均增加,所有血瘀证较术前均下降,而术后1周至术后1年脾肾两虚证、肾虚血瘀有所上升,脾胃虚弱证、气血亏虚证有所下降,但脾胃虚弱证仍位于第二位。4.在复发相关性研究中,经过Logistic回归分析提示:年龄小于24岁及30-34岁、痛经加重、术后痛经、术后1年血瘀证、术后1年气滞血瘀证、气虚血瘀证、肾虚血瘀证、痰湿瘀阻证可能为复发的危险因素,剖腹手术、合并术后经期延长可能为复发的保护因素。
结论:1.瘀血阻滞冲任、胞宫是EMS的基本病机,气滞血瘀证是EMS最常见的证型。2.术前主要证型为气滞血瘀证,以实证为主,术后血瘀证、气滞证明显减少,术后气虚证、血虚证明显增加,术后主要证型向气虚血瘀证转变。3.年龄小于24岁及30-34岁、痛经加重、术后痛经、术后1年血瘀证、术后1年气滞血瘀证、气虚血瘀证、肾虚血瘀证、痰湿瘀阻证可能为复发的危险因素,剖腹手术、合并术后经期延长可能为复发的保护因素。
Objective:To undertake prospective research based on clinical epidemiological research methods;to collect TOM syndromesof EMS patients before and after surgery,as well as possible to collect the factors that will influence the syndromes;and to discuss on the distribution and combination rules of the TCM syndromes before and after surgery and possible relativity for recurrence,and eventually provide symptomatic and epidemic evidence to prevent and treat against EMS,so that women and patients after surgery in various physical state can get effective preventive guide.
Methods:Firstly,Semi-open questionnaires are used to collect data of 208 post-operative EMS patients whose age range from 18 to 54,with average age of 36.56±7.94.Secondly,the TCM syndromes of EMS patients and possible influencing factors are collected.Thirdly,to conduct 1-year follow up visit and monitor patients' recurrence,and finally complete the preoperative and follow up questionnaires.
Results:This research has surveyed with 208 patients.1.Of the symptoms in survey,consecutive dysmenorrhea,worsening dysmenorrhea,infertility, hypermenorrhea,prolonged menstrual period,abnormal menstruation,darkred menstrual blood and bloodclots are the most seen ones.Light dark tongue, darkred tongue,tongue with petechia and ecchymosis,venation of tongue with winding,venous strings are the most seen symptoms.2.In the distribution of pre-surgery syndromes,firstly all with blood stasis,secondly Qi stagnation and kidney deficiency are major ones.In the distribution of one week post-surgery syndromes,firstly Qi deficiency,secondly blood stasis and kidney deficiency.During the period before surgery and 1 week after surgery, blood stasis,Qi stagnation and kidney deficiency evidently fall down,but Qi deficiency and blood deficiency obviously increase.During the period after surgery for 1 week to 1 year,kidney deficiency obviously increase,but Qi deficiency decrease to some extent,still remains as the first major syndromes. 3.blood stasis based Qi stagnation,blood stasis based kidney deficiency are major syndromes in the distribution of pre-surgery type.Weakness of the spleen and stomach,weakness of both the spleen and kidney are major syndromes for the type after surgery for one week and the type after surgery for one year as well.One week after surgery,weakness of the spleen and stomach,weakness of both Qi and blood,weakness of both the spleen and kidney obviously increase compared to that before surgery.All blood stasis syndromes decrease compared to that before surgery.As for the types after surgery for one week to one year, weakness of both the spleen and kidney,blood stasis base kidney deficiency increase to some extent while weakness of the spleen and stomach,weakness of both Qi and blood decrease.Nevertheless,weakness of both the spleen and kidney remains as the second major syndromes.4.In the relativity research for recurrence,through Logistic regression analysis it point that even one of the following risky factors——age under 24 or within the range from 30 to 34,worsening dysmenorrhea,dysmenorrhea after surgery,blood stasis,blood stasis based Qi stagnation,blood stasis based Qi deficiency,blood stasis based renal deficiency,wet sputum and stasis after surgery for 1 year are risky factors——will possibly cause recurrence,while we found out that laparotomy,bradymenorrhea after surgery are possibly protective factors against recurrence.
Conclusions:1.Blood stasis blocks chongren and baogong is the basic pathogenesis of EMS,blood stasis based Qi stagnation is the most common syndromes.2.Major pre-surgery syndromes is blood stasis based Qi stagnation, with practical syndromes as the most.Blood stasis and Qi stagnation decrease after surgery,while Qi deficiency and blood deficiency increase.The principal type of syndromes converts into the type of blood stasis based.Qi deficiency.3.Age under 24 or within the range from 30 to 34,worsening dysmenorrhea,dysmenorrhea after surgery,blood stasis,blood stasis based Qi stagnation,blood stasis based Qi deficiency,blood stasis based renal deficiency,wet sputum and stasis after surgery for 1 year are risky factors that will cause possible recurrence.Laparotomy,combining bradymenorrhea after surgery are possibly protective factors against recurrence.
方法:采用半开放式的问卷调查方式,收集208例经手术治疗确诊为EMS患者,发病年龄为18～54岁,平均年龄为36.56±7.94岁,收集EMS患者中医证候特征及可能的影响因素,并进行为期1年随访,观察患者复发情况,完成术前及随访调查表。
结果:本研究共调查208例患者,1.在症状调查中,继发性痛经、渐进性加重、不孕、月经过多,经期延长、经行不畅,经血暗红色,夹血块为最常见症状,舌淡暗、舌暗红,舌有瘀点瘀斑,舌底脉络迂曲,脉弦是最常见舌脉象。2.在术前证素分布中,全部出现血瘀证,其次以气滞证、肾虚证为主,术后1周以气虚证为主,其次为血瘀证、肾虚证;术前至术后1周血瘀证、气滞证、肾虚证明显下降,而气虚证、血虚证明显增加,术后1周至术后1年肾虚证明显增加,而气虚有所下降,但仍占第一位。3.在术前证型分布中,以气滞血瘀、肾虚血瘀为主,术后1周及术后1年证型均以脾胃虚弱、脾肾两虚为主;术后1周脾胃虚弱、气血亏虚、脾肾两虚证较术前均增加,所有血瘀证较术前均下降,而术后1周至术后1年脾肾两虚证、肾虚血瘀有所上升,脾胃虚弱证、气血亏虚证有所下降,但脾胃虚弱证仍位于第二位。4.在复发相关性研究中,经过Logistic回归分析提示:年龄小于24岁及30-34岁、痛经加重、术后痛经、术后1年血瘀证、术后1年气滞血瘀证、气虚血瘀证、肾虚血瘀证、痰湿瘀阻证可能为复发的危险因素,剖腹手术、合并术后经期延长可能为复发的保护因素。
结论:1.瘀血阻滞冲任、胞宫是EMS的基本病机,气滞血瘀证是EMS最常见的证型。2.术前主要证型为气滞血瘀证,以实证为主,术后血瘀证、气滞证明显减少,术后气虚证、血虚证明显增加,术后主要证型向气虚血瘀证转变。3.年龄小于24岁及30-34岁、痛经加重、术后痛经、术后1年血瘀证、术后1年气滞血瘀证、气虚血瘀证、肾虚血瘀证、痰湿瘀阻证可能为复发的危险因素,剖腹手术、合并术后经期延长可能为复发的保护因素。
Objective:To undertake prospective research based on clinical epidemiological research methods;to collect TOM syndromesof EMS patients before and after surgery,as well as possible to collect the factors that will influence the syndromes;and to discuss on the distribution and combination rules of the TCM syndromes before and after surgery and possible relativity for recurrence,and eventually provide symptomatic and epidemic evidence to prevent and treat against EMS,so that women and patients after surgery in various physical state can get effective preventive guide.
Methods:Firstly,Semi-open questionnaires are used to collect data of 208 post-operative EMS patients whose age range from 18 to 54,with average age of 36.56±7.94.Secondly,the TCM syndromes of EMS patients and possible influencing factors are collected.Thirdly,to conduct 1-year follow up visit and monitor patients' recurrence,and finally complete the preoperative and follow up questionnaires.
Results:This research has surveyed with 208 patients.1.Of the symptoms in survey,consecutive dysmenorrhea,worsening dysmenorrhea,infertility, hypermenorrhea,prolonged menstrual period,abnormal menstruation,darkred menstrual blood and bloodclots are the most seen ones.Light dark tongue, darkred tongue,tongue with petechia and ecchymosis,venation of tongue with winding,venous strings are the most seen symptoms.2.In the distribution of pre-surgery syndromes,firstly all with blood stasis,secondly Qi stagnation and kidney deficiency are major ones.In the distribution of one week post-surgery syndromes,firstly Qi deficiency,secondly blood stasis and kidney deficiency.During the period before surgery and 1 week after surgery, blood stasis,Qi stagnation and kidney deficiency evidently fall down,but Qi deficiency and blood deficiency obviously increase.During the period after surgery for 1 week to 1 year,kidney deficiency obviously increase,but Qi deficiency decrease to some extent,still remains as the first major syndromes. 3.blood stasis based Qi stagnation,blood stasis based kidney deficiency are major syndromes in the distribution of pre-surgery type.Weakness of the spleen and stomach,weakness of both the spleen and kidney are major syndromes for the type after surgery for one week and the type after surgery for one year as well.One week after surgery,weakness of the spleen and stomach,weakness of both Qi and blood,weakness of both the spleen and kidney obviously increase compared to that before surgery.All blood stasis syndromes decrease compared to that before surgery.As for the types after surgery for one week to one year, weakness of both the spleen and kidney,blood stasis base kidney deficiency increase to some extent while weakness of the spleen and stomach,weakness of both Qi and blood decrease.Nevertheless,weakness of both the spleen and kidney remains as the second major syndromes.4.In the relativity research for recurrence,through Logistic regression analysis it point that even one of the following risky factors——age under 24 or within the range from 30 to 34,worsening dysmenorrhea,dysmenorrhea after surgery,blood stasis,blood stasis based Qi stagnation,blood stasis based Qi deficiency,blood stasis based renal deficiency,wet sputum and stasis after surgery for 1 year are risky factors——will possibly cause recurrence,while we found out that laparotomy,bradymenorrhea after surgery are possibly protective factors against recurrence.
Conclusions:1.Blood stasis blocks chongren and baogong is the basic pathogenesis of EMS,blood stasis based Qi stagnation is the most common syndromes.2.Major pre-surgery syndromes is blood stasis based Qi stagnation, with practical syndromes as the most.Blood stasis and Qi stagnation decrease after surgery,while Qi deficiency and blood deficiency increase.The principal type of syndromes converts into the type of blood stasis based.Qi deficiency.3.Age under 24 or within the range from 30 to 34,worsening dysmenorrhea,dysmenorrhea after surgery,blood stasis,blood stasis based Qi stagnation,blood stasis based Qi deficiency,blood stasis based renal deficiency,wet sputum and stasis after surgery for 1 year are risky factors that will cause possible recurrence.Laparotomy,combining bradymenorrhea after surgery are possibly protective factors against recurrence.
引文
[1]乐杰主编.妇产科学第6版.人民卫生出版社,354.
[2]Eskenmazi B.Warner ML.Epidemiology of endometristsis.Obstet Gynecol Clin North Am,1997;24:235-238.
[3]沈蓉,田水杰.子宫内膜异位症的病因学研究进进展.山东卫生,2005;9:54-55.
[4]蒋青,王如英.子宫内膜异位症临床研究进展.大同医学专科学院学报,2003;3:23.
[5]赵佩琼.子宫内膜异位证术后辅助用药疗效分析.浙江临床医学杂志,2004:6:988-990.
[6]张晓更.子宫内膜异位症的辩证初探.陕西中医,2006;27(6):693.
[7]卢燕,徐晓宇,姜仪辉.从痰湿论治子宫内膜异位症.辽宁中医杂志,2006;33(4):410.
[8]薛雯,刘丽敏.消异汤治疗子宫内膜异位症90例.新中医,2007;39(11):57.
[9]张晓峰,王卫东.祛瘀解毒消咽汤治疗子宫内膜异位症78例临床分析.现代中医药,2007;27(5):18.
[10]张磊,朱佩芹.清异汤保留灌肠治疗直肠子宫内膜异位症疗效观察.四川中医,2007;25(12):84.
[11]王叶秀,杜晓萍.中药化瘀止痛液肛点治疗子宫内膜异位症的疗效观察.中华中医药学刊;2008;2:333.
[12]杨波,张军,黎海莉,等.中西医结合治疗术后子宫内膜异位症疗效观察.河北中医,2006:9:678-679.
[13]赵国平.证与证候异同论.山西中医,1990;6(2):6.
[14]秦伯末.中医“辨证论治”概说.江苏中医,1957;(1):2.
[15]印会和主编.中医基础理论.上海:上海科学技术出版社,1984,第一版;8.
[16]朱文峰.中医病证规范化之研究.中国医药学报,1996;11(5):6.
[17]张枢明整理.证的专家谈.中医杂志,1996;7:430.
[18]王忠,王安民,鞠大宏.“毒邪致络病”与证候及基因组关系的探讨.中医杂志,2000;41(8):500.
[19]陆广梓.“证一病正症”辨.中医杂志,1990;4:11.
[20]黎毅,梁伟雄,梁炳坤,等.椎动脉型颈椎病中医证候分布规律的临床流行病学调查.新中医,2007;39(7):47.
[21]潘峰,叶晓勤,郭建文,等.急性缺血中风阴阳类证证候分级阈值初探.中西医结合心脑血管病杂志,2007;5(7):595.
[22]雷燕,王振华,刘剑刚.血脂异常中医证候规律及其客观化研究.中国中西医结合杂志,2007;28:1074.
[23]胡节惠,莫涂波.心悸病心气虚证与心血瘀阻症患者sEDF含量变化的临床意义.实用中西医结合杂志,1998;11(10):888.
[24]张澄海,凌昌全,刘颖,等.现代细胞生物学与中医学说—BcL-2家族与中医肾本质关系探讨.细胞生物学杂志,1999;21(3):125.
[25]孙福立,李德明.试用睡眠剥夺法建立心虚证的动物模型.中西医结合杂志,1987;7(1):35.
[26]曲长江,刘劲.五种脾虚小鼠模型过氧化与抗氧化改变的比较研究.辽宁中医杂志,2000;7(27):329.
[27]刘士敬,朱倩.X射线照射大鼠腹部塑造脾气虚模型的研究.辽宁中医杂志,1997;7(24):331.
[28]周英.脾虚和肾虚雌性大鼠生育能力的实验观察.广州中医药大学学报,1998;3(15):195.
[29]王志莲,岳月娥.子宫内膜异位症的免疫状态与中医辨证分型的关系.中国中医基础医学杂志,2007;11:33.
[30]杨鉴冰,张潮红.血瘀型子宫内膜异位症大鼠模型的实验研究.中国中医基础医学杂志,2007;11:774.
[31]冉青珍,陈万群.肾虚血瘀证子宫内膜异位症不孕症动物模型的建立与评价.辽宁中医药大学学报,2008;1:130.
[32]曹泽毅主编.中华妇产科学.北京:人民卫生出版社,1999;1299.
[33]Muzii L.Marana R,Caruana P.et al.Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometrioms:A prospective,randomized trial.Am J Obstet Gynecol.2000,183:588-592.
[34]RajkamarK,Schott PW,Simpson CW,et al.The rat as an animal model for endometriosis to exam recurrence of ectopic endometrial tissue after regression[J].Fertil Steril,1990,53:921-924.
[35]陈棣仪,石一复.240例盆腔子宫内膜异位症术后复发的探讨.妇产科进展,2002;11(6):424-426.
[36]赵轩,刘俊丽,陈世荣,等.子宫内膜异位症手术治疗后复发相关因素的分析.中华妇产科杂志,2006;10(10):669-671.
[37]Parazzini F,Bertulessi C,Pasini A,et al.Determinants of short term recurrence rate of endometriosis.Eur J Obstet Gynecol Reprod Biol,2005:121:216-219.
[38]肖青,薛素华,唐家龄,等.子宫内膜异位症术后复发的相关因素分析.中国医学理论与实践,2003;6:780-781.
[39]第七届国际子宫内膜异位症会议纪要.国外医学妇产科分册.2001;28:40-42.
[40]解孝实,邴德风.米非司酮预防卵巢子宫内膜异位囊肿术后复发56例临床分析.山东医药,2004;44(32):65.
[41]Domnez,J.Int J Gynaecol Obstet,1999;64(suppl 1):55.
[42]李华军,冷金花,郎景和,等.子宫内膜异位症保守性手术后复发的相关因素分析.中华妇产科杂志,2005;1:13-16.
[43]Ghezzi F,Beretta P,Franchi M,et al.Recurrence of ovarian endometriosis and anatomical location of the primary lesion.Fertil Steril.2001;75:136-140.
[44]程兰,谭敏华,李雪梅.不同干预方法对卵巢子宫内膜异位囊肿术后复发影响的临床研究.新中医,2008;40(8):59-60.
[45]韦成厚,姚书忠,许玉芳,等.腹腔镜下卵巢子宫内膜异位囊肿剥除术后复发相关因素分析.中国计划生育学杂志,2004;10:617-620.
[46]李梅生,谭布珍,张萍,等.子宫内膜异位症现代治疗.北京:人民军医出版社,2003;第一版;72.
[47]郝梅,石一复,黄文岳.子宫内膜异位症患者腹腔白细胞介素6,8及转化因子β1的测定.中华妇产科杂志,2000;33(6):329-331.
[48]Jones KD.Fan A.The ovarian endometrioma:why is it so poorly managed Indicators from an anonymous survey.Sutton CJ.Hum Reprod,2002;17(4):845-849.
[49]Dawood MY.Dysmenorrhea.Clin Obstet Gynecol.1990;33(1):168-178.
[50]林津,马炎辉.卵巢子宫内膜异位症相关因素分析.中国妇幼保健,2007;22,570-572.
[2]Eskenmazi B.Warner ML.Epidemiology of endometristsis.Obstet Gynecol Clin North Am,1997;24:235-238.
[3]沈蓉,田水杰.子宫内膜异位症的病因学研究进进展.山东卫生,2005;9:54-55.
[4]蒋青,王如英.子宫内膜异位症临床研究进展.大同医学专科学院学报,2003;3:23.
[5]赵佩琼.子宫内膜异位证术后辅助用药疗效分析.浙江临床医学杂志,2004:6:988-990.
[6]张晓更.子宫内膜异位症的辩证初探.陕西中医,2006;27(6):693.
[7]卢燕,徐晓宇,姜仪辉.从痰湿论治子宫内膜异位症.辽宁中医杂志,2006;33(4):410.
[8]薛雯,刘丽敏.消异汤治疗子宫内膜异位症90例.新中医,2007;39(11):57.
[9]张晓峰,王卫东.祛瘀解毒消咽汤治疗子宫内膜异位症78例临床分析.现代中医药,2007;27(5):18.
[10]张磊,朱佩芹.清异汤保留灌肠治疗直肠子宫内膜异位症疗效观察.四川中医,2007;25(12):84.
[11]王叶秀,杜晓萍.中药化瘀止痛液肛点治疗子宫内膜异位症的疗效观察.中华中医药学刊;2008;2:333.
[12]杨波,张军,黎海莉,等.中西医结合治疗术后子宫内膜异位症疗效观察.河北中医,2006:9:678-679.
[13]赵国平.证与证候异同论.山西中医,1990;6(2):6.
[14]秦伯末.中医“辨证论治”概说.江苏中医,1957;(1):2.
[15]印会和主编.中医基础理论.上海:上海科学技术出版社,1984,第一版;8.
[16]朱文峰.中医病证规范化之研究.中国医药学报,1996;11(5):6.
[17]张枢明整理.证的专家谈.中医杂志,1996;7:430.
[18]王忠,王安民,鞠大宏.“毒邪致络病”与证候及基因组关系的探讨.中医杂志,2000;41(8):500.
[19]陆广梓.“证一病正症”辨.中医杂志,1990;4:11.
[20]黎毅,梁伟雄,梁炳坤,等.椎动脉型颈椎病中医证候分布规律的临床流行病学调查.新中医,2007;39(7):47.
[21]潘峰,叶晓勤,郭建文,等.急性缺血中风阴阳类证证候分级阈值初探.中西医结合心脑血管病杂志,2007;5(7):595.
[22]雷燕,王振华,刘剑刚.血脂异常中医证候规律及其客观化研究.中国中西医结合杂志,2007;28:1074.
[23]胡节惠,莫涂波.心悸病心气虚证与心血瘀阻症患者sEDF含量变化的临床意义.实用中西医结合杂志,1998;11(10):888.
[24]张澄海,凌昌全,刘颖,等.现代细胞生物学与中医学说—BcL-2家族与中医肾本质关系探讨.细胞生物学杂志,1999;21(3):125.
[25]孙福立,李德明.试用睡眠剥夺法建立心虚证的动物模型.中西医结合杂志,1987;7(1):35.
[26]曲长江,刘劲.五种脾虚小鼠模型过氧化与抗氧化改变的比较研究.辽宁中医杂志,2000;7(27):329.
[27]刘士敬,朱倩.X射线照射大鼠腹部塑造脾气虚模型的研究.辽宁中医杂志,1997;7(24):331.
[28]周英.脾虚和肾虚雌性大鼠生育能力的实验观察.广州中医药大学学报,1998;3(15):195.
[29]王志莲,岳月娥.子宫内膜异位症的免疫状态与中医辨证分型的关系.中国中医基础医学杂志,2007;11:33.
[30]杨鉴冰,张潮红.血瘀型子宫内膜异位症大鼠模型的实验研究.中国中医基础医学杂志,2007;11:774.
[31]冉青珍,陈万群.肾虚血瘀证子宫内膜异位症不孕症动物模型的建立与评价.辽宁中医药大学学报,2008;1:130.
[32]曹泽毅主编.中华妇产科学.北京:人民卫生出版社,1999;1299.
[33]Muzii L.Marana R,Caruana P.et al.Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometrioms:A prospective,randomized trial.Am J Obstet Gynecol.2000,183:588-592.
[34]RajkamarK,Schott PW,Simpson CW,et al.The rat as an animal model for endometriosis to exam recurrence of ectopic endometrial tissue after regression[J].Fertil Steril,1990,53:921-924.
[35]陈棣仪,石一复.240例盆腔子宫内膜异位症术后复发的探讨.妇产科进展,2002;11(6):424-426.
[36]赵轩,刘俊丽,陈世荣,等.子宫内膜异位症手术治疗后复发相关因素的分析.中华妇产科杂志,2006;10(10):669-671.
[37]Parazzini F,Bertulessi C,Pasini A,et al.Determinants of short term recurrence rate of endometriosis.Eur J Obstet Gynecol Reprod Biol,2005:121:216-219.
[38]肖青,薛素华,唐家龄,等.子宫内膜异位症术后复发的相关因素分析.中国医学理论与实践,2003;6:780-781.
[39]第七届国际子宫内膜异位症会议纪要.国外医学妇产科分册.2001;28:40-42.
[40]解孝实,邴德风.米非司酮预防卵巢子宫内膜异位囊肿术后复发56例临床分析.山东医药,2004;44(32):65.
[41]Domnez,J.Int J Gynaecol Obstet,1999;64(suppl 1):55.
[42]李华军,冷金花,郎景和,等.子宫内膜异位症保守性手术后复发的相关因素分析.中华妇产科杂志,2005;1:13-16.
[43]Ghezzi F,Beretta P,Franchi M,et al.Recurrence of ovarian endometriosis and anatomical location of the primary lesion.Fertil Steril.2001;75:136-140.
[44]程兰,谭敏华,李雪梅.不同干预方法对卵巢子宫内膜异位囊肿术后复发影响的临床研究.新中医,2008;40(8):59-60.
[45]韦成厚,姚书忠,许玉芳,等.腹腔镜下卵巢子宫内膜异位囊肿剥除术后复发相关因素分析.中国计划生育学杂志,2004;10:617-620.
[46]李梅生,谭布珍,张萍,等.子宫内膜异位症现代治疗.北京:人民军医出版社,2003;第一版;72.
[47]郝梅,石一复,黄文岳.子宫内膜异位症患者腹腔白细胞介素6,8及转化因子β1的测定.中华妇产科杂志,2000;33(6):329-331.
[48]Jones KD.Fan A.The ovarian endometrioma:why is it so poorly managed Indicators from an anonymous survey.Sutton CJ.Hum Reprod,2002;17(4):845-849.
[49]Dawood MY.Dysmenorrhea.Clin Obstet Gynecol.1990;33(1):168-178.
[50]林津,马炎辉.卵巢子宫内膜异位症相关因素分析.中国妇幼保健,2007;22,570-572.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |