Clinical Study On Nuangong Zhuyun Decoction Combined With Hysteroscopy-Laparoscopy Surgery For Tubal Obstructive Infertility Of Cold Coagulation With Blood Stasis Type

Objective:To observe the difference in clinical efficacy between Nuangong Zhuyun decoction combined with hysteroscopy-laparoscopy surgery and hysteroscopy-laparoscopy surgery alone in the treatment of tubal obstructive infertility(cold coagulation and blood stasis type),so as to explore the mechanism,efficacy and safety of the therapeutic method for this disease,and provide more theoretical basis and suggestions for clinical therapy of this disease.Methods:A total of 66 patients with tubal obstructive infertility who were in the treatment in the Department of Gynecology,Affiliated Hospital of Jiangxi University of TCM from December 2020 to January2022 were selected after the screening of inclusion criteria and exclusion criteria,and their syndrome differentiation of TCM was cold coagulation and blood stasis type.All patients were numbered according to the order of treatment and randomly separated into observed group and control group with 33 cases each.All patients enrolled received hysteroscopy-laparoscopy surgery on the 3rd to 7th day after menstruation,and received routine infection-prevention therapy after surgery.The patients in the observation group were given oral Nuangong Zhuyun decoction for 10 days after postoperative anal exhaust,and were given the medicine again for 10 days from the fifth day of menstruation in the following month for 3 menstrual cycles.All patients were followed up for half a year after surgery.The differences of TCM syndrome scores,local signs scores and pregnancy after surgery were compared before therapy and post-treatment in the integrated clinical efficacy of the two groups was assessed by statistical analysis.Results:During the study,30 cases,as a matter of fact,were completed in the observed group and 31 cases in the control group because of shedding cases.Compare the two groups’ baseline data before surgery,including patients’ age,course of disease,types of infertility,the condition of fallopian tube obstruction,TCM syndrome score and local sign score.All the results showed P > 0.05 by statistical test,which indicated that the difference is not statistically significant and is comparable.1.Comprehensive clinical efficacy:According to the criteria for determining efficacy,after treatment,total effective rate in the observation group was 90.00%(27/30),and control group was 67.74%(21/31).There was a statistical difference between the overall effective rate of the two groups(P<0.05),which suggested that Nuangong Zhuyun decoction associated with hysteroscopy-laparoscopy surgery in the treatment of tubal obstructive infertility was markedly more effective than that of hysteroscopy-laparoscopy surgery alone.2.The condition of pregnancy in the post-treatment:Patients were followed-up for half a year after surgery.After the treatment of 3menstrual cycles,the rate of pregnancy in the observed group was 76.67%(23/30)and the intrauterine pregnancy rate was 70.00%(21/30);the pregnancy rate in the control group was 48.39%(15/31)and the intrauterine pregnancy rate was 35.48%(11/31).By comparing the cumulative pregnancy and intrauterine pregnancy between the two groups,the test showed that P<0.05,with statistical difference.The effect of traditional Chinese medicine combined with hysteroscopy-laparoscopy surgery was better than that of hysteroscopy-laparoscopy surgery alone in improving the pregnancy rate and intrauterine pregnancy rate.In addition,there were ectopic pregnancy outcome patients in both groups,including 2 patients of ectopic pregnancy in the observed group and 4patients in the control group.By comparing the condition of ectopic pregnancy between the two groups,the test showed that P>0.05,with no statistical difference.3.The efficacy of TCM syndrome : After 3 menstrual cycles of treatment,the total effective rate of improvement of TCM related symptoms was 90.00%(27/30)in the observation group and 54.84%(17/31)in the other group.The rank sum test yielded the results that P<0.05,and there were statistically significant differences.Both groups could alleviate the syndrome of cold coagulation and blood stasis,but the observation group had better effect.4.The efficacy of local sign:Recorded the scores of local sign before and after treatment,and calculated the efficacy index according to Nimodipine method.By statistically analyzing,the total effective rate was 90.00%(27/30)in the observed group and 54.84%(17/31)in the other group.The rank sum test showed that P<0.01,with apparent difference.The local signs of two groups were improved,but the improvement effect of the observed group was obviously better than that of the other group.Conclusion:Clinically,for the patients with tubal obstructive infertility of cold coagulation with blood stasis type,oral Nuangong Zhuyun Decoction combined with hysteroscopy-laparoscopy surgery can more effectively improve the relevant symptoms and local signs of the patients,improve the intrauterine pregnancy rate of the patients than hysteroscopy-laparoscopy surgery alone,and the safety of this treatment is high,which is worth studying and further exploring,and provide better ideas and value for clinical application.