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全生妇科十讲7: 子宫内膜异位症(10/25/2011)
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全生妇科十讲7: 子宫内膜异位症(10/25/2011)

子宫内膜异位症 (Endometriosis,EM),是指具有生长功能的子宫内膜组织出现在子宫腔被覆黏膜以外的身体其他部位。临床上常见有盆腔子宫内膜异位症 (Pelvic endometriosis). 异位子宫内膜可出现在身体的不同部位,但绝大多数位于盆腔内的卵巢、宫能韧带、子宫后壁的浆膜面以及覆盖于子宫直肠陷凹、乙状结肠的腹膜层和阴道直肠隔,其中浸犯卵巢者最常见,约占80%。当子宫内膜出现和生长在子宫肌层,未扩散至子宫浆膜层时称为子宫腺肌病 (adenomyosis);此外,少见的部位如中枢神经系统、横纹肌、手、臂、大腿处均可发病,但极罕见。

 临床表现常表现为痛经,月经不调,不孕,盆腔结节或包块等。由于异位内膜亦受月经周期中卵巢激素的影响而增厚、出血,但不能引流而刺激周围组织,从而引起子宫收缩,导致痛经。临床表现因人而异,可因病变部位不同而出现不同症状,大约20%患者无明显不适。

子宫内膜异位症在发达国家妇女总人群中的发生率约为10%。其中以腹膜EM最多见,普遍认为其病因为经血逆流。本病发生常与人流手术、经期性交、大年龄、长期应用阴道塞等因素有关。另外还与遗传及环境因素有关。现在发现紧身衣与EM发生亦有—定关系。

 许多医家对子宫内膜异位症的发病机制和治疗方法进行了深入细致的研究,认为子宫内膜异位症临床表现的疼痛和不适,严重影响了妇女的身心健康,给育龄妇女的生活工作带来了极大的痛苦。其虽为良性疾病,但症状顽固,有极易复发、再发的特点,异位的内膜组织可像恶性肿瘤一样播散种植与转移,没有理想的治疗方法,疗效都是有限和暂时的。最新资料统计,任何方法的治疗,其5年复发率都在40%以上,治疗十分棘手。因此,将子宫内膜异位症列为疑难病症之一。

 目前西医主要采用激素和手术治疗,有副作用大、复发率高之弊。且内膜异位症患者多为年轻妇女,存在生育问题,故保守治疗极受临床医师关注, 而中医针灸对子宫内膜异位症的治疗有优势。一随机对照临床研究报告显示,中药和针灸能明显改善盆腔子宫内膜异位症的痛经症状(Cochrane Database Syst Rev. 2011)。    

子宫内膜异位症属于中医"痛经"、"不孕"、"症瘕"及"月经不调"范畴. 胞宫(子宫)藏泻功能的生理表现为:平时藏而不泻,月经期泻而不藏,定时将经血排出体外。若心情抑郁、劳伤气血、房事不节或手术创伤等,导致冲任损伤,胞宫藏泻功能异常,月经期经血虽有所泻,但部分经血不循常而逆行,以致"离经之血"蓄积体内而成瘀血。瘀血阻滞不去,新血无以归经,则产生疼痛。瘀血为本病之病理产物,又为本病之病因病机。"瘀"是产生内膜异位的关健。 

临床可分为肾气亏虚、气血虚弱,气滞血瘀、寒凝血瘀、湿热蕴结和痰瘀互阻等证型。治疗大法调理气血。以活血化瘀,软坚散结为主,佐以行气化痰,兼调寒热,兼治肾虚,兼以通腑等。 

清代《医宗金鉴》有一桃红四物汤,活血祛瘀,根据其加减,主治各种子宫内膜异位症。如加强补肾之品,益肾调经,活血祛瘀,主治子宫内膜异位症肾虚型,症见经行或经后腹痛,腰脊酸楚,引及下肢及破臀,头晕目眩,经期先后不定期,经量或多或少,淋漓不尽,或见血块。日久不孕或易流产,舌黯滞,或有瘀斑或瘀点等。  

下期敬请关注全生妇科十讲8: 盆腔炎. 更多全生讲中医, 敬请访问卢全生中西医结合博士的网站www.wholelifeherb.com,或直接拨打中文热线电话301-340-7682,301-919-9898约诊. 全生中医针灸医疗中心地址:  416 Hungerford Dr, Suite 215, Rockville, MD 20850. 或 9801 Georgia Ave, Suite 337, Silver Spring, MD 20902

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