| Objective:This paper analyzed the correlation between the TCM Syndrome Types and the age of patients,the dysmenorrhea,the menstrual abnormalities,the surgical r-AFS staging,the fertility index(EFI),the Least Function Scoring System(LF),the endometriosis lesions score,the pelvic adhesion score and the type of infertility,to explore the correlation between the TCM syndromes and the epidemiological data in the patients with endometriosis This research result was aimed at providing a theoretical basis for treatment based on syndrome differentiation and the combination of disease differentiation and syndrome differentiation,and providing a theoretical some suggestions and foundation for the based parameterization,standardization and modernization of the traditional Chinese medicine and the TCM syndrome type of foundation,standardization and modernization.This paper was aimed to explore the correlation between the TCM Syndrome Types of the endometriosis patients and laparoscopic conservative treatment surgery by comparing the difference of the pregnancy rate and the pregnancy time,the dysmenorrhea and menstrual abnormalities,which would develop ?the different syndrome type of endometriosis patients with individualized treatment programs for the clinicians and provide a theoretical basis,in order to provide guidance for integrated traditional Chinese and Western medicine treatment.Methods:This study investigated the 752 patients using retrospective study method and telephone follow-up form who were diagnosed with endometriosis by the laparoscopic conservative surgery and pathology in the Department of Gynecology,the First Affiliated Hospital of Guangzhou University of traditional Chinese medicine hospital from January 2009 to May 2015.Review and arrange the clinical datas of all patients one by one,then collecte the TCM syndrome type,age,chief complaint,infertility menstrual history,dysmenorrhea,intraoperative endometriotic lesion score,the adhesion score,fallopian tube function score,r-AFS staging,Endometriosis Fertility index Least Function Scoring System,the size of postoperative cyst,intraoperative bleeding volume,the long of surgery,endometriosis type,et al.Arrange and fill in the table of cases observed.Collected the treatment of patients after surgery,postoperative general health status,detailed records of patients with postoperative 6 months and after 12 months of dysmenorrhea,menstrual period and color quality,pregnancy or not and time to pregnancy,finishing and fill in case the questionnaire.All above informations were established an excel database and analyzed by SPSS22.0 software.Use the way of descriptive analysis to analysis the syndrome distribution.The measurement data using + s said,normal distribution data using t test or F analysis,non normal distribution or variance not neat data using Kruskal Wallis h test,count data used to check and pregnancy factors by single factor analysis and multivariate logistic regression analysis method to P<0.05,the difference was statistically significant.Results:1.The topic of 752 patients with endometrial endometriosis associated infertility patients survey found that,the disease to 25?40 year old high age,account for%of the total number of cases,of which 25~34 years of age accounted for 80.340%,and the epidemiological characteristics of the disease incidence Yu Yuling women are meet.The disease mainly in the "kidney deficiency and blood stasis,qi stagnation and blood stasis,phlegm and blood stasis mutual knot,hot and humid and blood stasis,Qi deficiency and blood stasis" five card type,see also "congealing cold and blood stasis,spleen and kidney deficiency blood stasis and stagnation of liver qi deficiency and blood stasis,kidney deficiency and liver qi stagnation and blood stasis syndrome type four.However,the percentage of small proportion.Has similarities with the authoritative literature works of syndromes,which to kidney deficiency and blood stasis is the most common,secondly as qi stagnation and blood stasis,phlegm and blood stasis in Lingnan area each node higher in the type and damp heat and blood stasis syndrome is reported in the literature,and typical of the type of cold coagulation and blood stasis accounted for only 1.73%,which with the regional climate characteristics of Lingnan are closely related.And all patterns were seen in the blood stasis,and blood stasis is the basic pathology of endometriosis is consistent,from the result of this research shows,the production of blood stasis and liver,spleen and kidney three dirty function disorder is closely related to,and kidney deficiency,qi stagnation,phlegm,heat,Qi deficiency,cold coagulation,and spleen deficiency are blood stasis caused by pathogenic factors.2.Different ages of TCM syndrome type distribution has significant difference,29-34 years and 35?40 years to kidney deficiency and blood stasis type mostly,25?28 years with qi stagnation and blood stasis type accounted for a higher proportion,and other syndrome type group difference was statistically significant(P<0.05).3.Endometriosis clinical appearance of refractory infertility,dysmenorrhea,menstrual abnormalities,pelvic block,chronic pelvic pain and other forms,the infertility clinic,the most common reason for treatment,included 752 patients with endometriosis 640 cases with infertility as the chief complaint of admission,accounting for the total number of cases of 85.11%.And with normal menstruation in patients with endometriosis the majority,abnormal accounted for only 32.45%;with painless the majority,dysmenorrhea 43.75%,severe dysmenorrhea accounted for only 2.13%,so it leads to infertility or endometriosis clinical urgently awaits to be solved the first problem.4 subjects of different syndrome types of patients with primary infertility and secondary infertility than the statistics found that there was no significant correlation between the type of infertility and TCM syndrome type distribution,the difference was not statistically significant(P>0.05).5.Clinical in various syndromes of patients can be accompanied by abnormal menstruation,whether the merger menstrual abnormalities and abnormal menstruation severity in different syndrome type difference between the two groups has statistical significance,244 Cases of menstrual disorder patients,with kidney deficiency and blood stasis menstrual abnormality is the most common,menstruation integral is the highest,and other syndrome type group difference has statistical significance(P<0.05).6.329 cases with dysmenorrhea patients,phlegm and blood stasis in each node type dysmenorrhea with slightly higher proportion,accounting for 57.6%with syndromes of patients,secondly for damp heat and blood stasis type,different dysmenorrhea points are not the same,the phlegm stasis each node type and damp heat and blood stasis dysmenorrhea score slightly higher,but the syndrome patients not with severity of dysmenorrhea,dysmenorrhea by statistical difference was not statistically significant(P>0.05).7.To 752 subjects endometriotic lesion score,pelvic adhesion score and R-AFS staging,found that the endometriotic lesion highest score for 46 points,there were 1 case,the lowest score for 1 points,a total of 134 cases,the average score + 8.31 11.67,different syndromes group between endometriotic lesion score no significant difference(P>0.05).Adhesion of the highest score is 104 points,a total of 5 cases,the lowest score was 0 points,a total of 206 cases,the average score was 16.62 + 22.65.752 subjects pelvic adhesion accounted for only 27.39%.Most of the patients had different degree of adhesion,and reported in the literature endometriosis approximately 80%of patients exist more or less of the fallopian tube and pelvic problem is similar to the result.High in damp heat and blood stasis.The adhesion score of pelvic adhesions in patients with no significant difference between the two groups(P>0.05).R-AFS staging in stage I,II,III,IV patients between the proportion,in different syndrome type distribution showed no statistical significance(P>0.05),the patients were to kidney deficiency and blood stasis type most,accounting for 44.28%of the total number of cases,followed by qi stagnation and blood stasis type,accounting for 29.65%of the total number of cases.8.patients with endometriosis lf mostly to high achievers,8 points accounted for the proportion of the total 26.86%,7 points accounted for 12.63%of the proportion of the total,6 points accounted for the proportion of the total 21.14%,5 points accounted for the proportion of the total 11.57%,4 points accounted for 12.63%of the proportion of the total lf low proportion of less,3 points accounted for the proportion of the total 3.72%,2 points accounted for the proportion of the total 8.91%,1 accounted for the proportion of the total 1.20%,0 accounted for the proportion of the total 1.33%,the average score 5.69 percent.According to the effect of different LF on pregnancy and EFI standard for evaluation of LF segmentation method,which is divided into 0 sections,4~3~6,7~8 segment piecewise three levels.LF with 4~6 segment who accounted for the highest proportion of a total of 341 cases,accounting for 45.34%,followed by 7 to 8 segments in 297 cases,accounting for 39.49%,0 to 3 points less,accounting for 15.16%.Comparison of different lf of scores of TCM syndrome type distribution.It is found that the scores were in the number of cases of kidney deficiency and blood stasis type most,followed by qi stagnation and blood stasis type,difference between 2 and 5 groups of syndromes group no statistical significance(P>0.05).9.EFI average 7.90 percent,the lowest score 2 points,in 3 cases,(0.40%,the highest score is 10 points,a total of 92 cases,accounted for 12.23%.Patients with EFI concentrated mostly in 8,9 patients,respectively,accounting for the total number of cases 26.06%and 27.26%,followed by 7 points,jection 17.69%,6,5,4,3 patients were accounted for by 9.84%,3.85%and 2.53%,0.13%.According to the influence of EFI on fertility were different,which can be divided into 0 groups and 5~4~10 group,the latter 729 cases,accounting for 96.94%of the total cases.By comparing the different EFI score in patients with TCM syndrome type distribution is found,the scores of patients were with kidney deficiency and blood stasis,followed by qi stagnation.10.6 months and 12 months postoperatively in patients with dysmenorrhea symptom integral decreased obviously,compared with the preoperative differences statistically significant(P<0.05),postoperative 12 months after six months of a group of symptoms integral group decreased obviously,statistically significant difference(P<0.05).Different syndrome patients 6 month after operation,postoperative points compared with preoperative symptoms were significantly decreased in December,statistically significant difference(P<0.05),postoperative 6 months after December the dysmenorrhea symptom score decreased significantly(P<0.05).Dysmenorrhea symptom integral difference between different syndrome group differences statistically significant(P<0.05),phlegm and blood stasis mutual junction,the resistance to hot and damp stasis type difference than other each card type group increased significantly,statistically significant difference(P<0.05),more than there was no statistically significant difference between the each card type group(P>0.05).11.Patients with 6 months and 12 months after menstruation integral decreased obviously,compared with the preoperative differences statistically significant(P<0.05),and 12 months postoperatively group 6 months after menstruation integral is markedly reduced,statistically significant difference(P<0.05).Different syndrome patients postoperative 6 months and 12 months after menstruation points before operation were significantly decreased,statistically significant difference(P<0.05)),postoperative December 6 months postoperatively significantly decreased(P<0.05).Menstrual points difference between different syndrome group differences statistically significant(P<0.05),kidney and blood stasis type of difference between the highest,followed by qi and blood stasis type,the comparative differences statistically significant(P<0.05),compared with other each card type group differences statistically significant(P<0.05),more than all the there was no statistically significant difference between the syndrome group(P>0.05).12.The communist party of China 752 patients,446 cases of pregnancy,postoperative cumulative pregnancy rate was 59.31%,according to the different groups are pregnancy time comparison,found that after 6 months,a total of 255 cases of patients with pregnancy,the pregnancy rate was 57.17%,postoperative 6 months to 12 months,126 cases of postoperative patients with pregnancy,the pregnancy rate was 28.3%,more than a year after the cumulative pregnancy rate of only 14.57%,comparing differences between groups with statistical significance(P<0.05).In different periods in kidney and blood stasis type and qi and blood stasis type pregnancy rate is higher,but the statistics postoperative pregnancy rate differences between different syndrome types have no statistical significance(P>0.05).13.In pregnancy or not affect outcomes,using the single factor analysis,comparative analysis of different factors,found that patients with endometriosis infertility in fixed number of year of the age,LF score,EFI score,infertility differences statistically significant(P<0.05),while history of surgery,type of infertility,ectopic lesions grading,adhesion grade,the different type of lesion,r-AFS in installment,of traditional Chinese medicine and whether abnormal menstrual dysmenorrhea,whether the merger,there was no statistically significant difference(P>0.05).Has statistical significance of the four factors influencing the Logistic regression analysis found that the function of fallopian tube(LF),fertility index(EFI)as the protective factors of postoperative pregnancy,higher score the two,postoperative pregnancy rate to rise.And age,infertility patients with fixed number of year,through multiple factor analysis showed there was no statistically significant difference,consider some correlation between variables.Conclusion:1.The blood stasis resistance at the basic pathogenesis of endometriosis,the generation of blood stasis is closely related to the dysfunction of liver and spleen and kidney,and kidney,qi deficiency and qi stagnation,phlegm turbidity,damp and hot,and haemorrheological nature,pixu(spleen deficient),and so on are the cause of blood stasis to produce.The disease basically has"the kidney and blood stasis,qi and blood stasis,phlegm and blood stasis and knot,the resistance to hot and damp stasis qi deficiency,blood stasis"five card type,see "haemorrheological nature and blood stasis,spleen and kidney deficiency and blood stasis,change the blood stasis,kidney and liver blood stasis" four card type,but the proportion is less,and authority in the literature evidence type is similar,of which is the most common kidney and blood stasis type,followed by qi and blood stasis type.2.Traditional Chinese medicine can significantly improve the different disease in patients with abnormal menstruation and dysmenorrhea symptoms,improve the clinical pregnancy rate,regulate the menstrual function have different analgesic effect,but different kind of this syndrome of kidney and blood stasis type and better regulate the menstrual function,qi stagnancy and blood stasis syndrome and phlegm and blood stasis mutual junction and dampness heat and blood stasis resistance to better pain relief effectiveness.3.The infertility is the emphasis and difficulty in clinical treatment of endometriosis,vision disorder infertility patients with postoperative within 6 months of pregnancy the golden age,when combined with postoperative patients,positive to individualized assisted measures to improve the pregnancy rate.LF score and EFI score to predict postoperative naturally conceived force has important guiding significance to the higher score the two,postoperative pregnancy rate is high;R-AFS in installment,TCM syndrome type and there was no obvious correlation in pregnancies,limited value for postoperative fertility prediction.4.The disease happens in childbearing age women,different age paragraph the different TCM syndrome type distribution,and menstrual abnormalities are different,different kind of this syndrome clinical when combined with patient age,and the type of each have emphasize particularly on different sent party drugs;But different in the TCM syndrome type and the type of infertility,whether with menstrual cramps and pain severity score,in different lesions and pelvic adhesion score,LF a grade,EFI,r-AFS and no obvious correlation between postoperative clinical pregnancy rate. |
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