中醫治療子宮內膜異位囊腫術後復發病例報告

Recurrence of Endometrioma after Surgical Treatment Treated with Traditional Chinese Medicine-A Case Report

李佳穎(Chia-Ying Lee) ； 羅綸謙(Lun-Chien Lo) ； 吳慈榮(Cih-Rong Wu) ； 陳文娟(Wun-Jyuan Chen)

《中醫藥雜誌》 24卷1期 (2013/06) Pp. 153-165

https://doi.org/10.6940/JCM.201306_24(1).13

摘要

這是一位四十五歲的女性，2005年因右下腹悶痛及陰道不正常出血至婦產科門診檢查，診斷為子宮肌瘤。並進行子宮肌瘤切除及左邊卵巢囊腫切除。術後服藥期間熱潮紅、月經停止來潮。2009年左側卵巢囊腫復發，診斷為子宮內膜異位瘤，並於同年切除左側部分卵巢。2010年又發現子宮後壁肌瘤及右側卵巢囊腫。患者因子宮肌瘤及卵巢內膜異位囊腫反覆發作至中醫門診治療。當時容易疲倦、右下腹不舒、腰痠甚、開刀後腰痛作，眠不佳不易入睡。臨證診斷為肝鬱氣滯、肝腎陰虛為本，濕熱痰瘀結於下焦為標，治療方向以疏肝理氣，活血化瘀為主，佐以清利濕熱，搭配滋陰固本。處方以加味逍遙散、桂枝茯苓丸、龍膽瀉肝湯等加減，期間搭配補腎滋陰、安神止痛等藥物。在治療將近六個月後，CA125指數在連續使用中藥治療的情況下明顯降低。臨床症狀於治療後，腹痛情況減輕，疲倦感紓緩，右側卵巢囊腫更有縮小之趨勢。提供作為中醫治療術後復發之子宮內膜異位囊腫的一有效臨床案例。

關鍵字

子宮內膜異位症 ； CA-125 ； 中醫 ； 病例報告

並列摘要

This 45 y/o female who had right lower abdominal dull pain and abnormal vaginal bleeding visited Obstetrics and Gynecology OPD clinic in 2005. She had had myomectomy and left ovarian cystectomy because Multiple uterine myoma was diagnosed. She was experienced hot flashes and menopause during postoperative medication. In 2009, because the recurrence of ovarian endometrioma, laparascopic left partial oophorectomy was performed. In 2010, posterior uterine myoma and right ovarian endometrioma was suspected. She suffered from fatigue, right lower abdominal dull pain, backache, and insomnia. Based on the patient's condition, the method of relieving Qi Stagnancy in Liver, promoting blood circulation and removing blood stasis, clearing Heat and eliminating Dampness, and nourishing yin was prescribed throughout the whole treatment period, and herbal remedies such as Jiawei Xiaoyao San, guizhi fuling wan, and longdan xiegan Tang was prescribed. The herb of nourishing yin, tonifying the kidney, tranquilizer, and analgesia was applied during the treatment period. After nearly 6 months of Traditional Chinese medicine treatment, the patient's serum CA-125 level was substantially decreased and the size of right ovarian cyst was gradually reduced. The result suggested us confidently that the Traditional Chinese medicine would provide better medical care for recurrence of endometrioma after surgical treatment.

並列關鍵字

Endometrioma ； CA125 ； traditional Chinese medicine ； case report

參考文獻

The ESHRE Guideline on Endometriosis 2008. http://guidelines.endometriosis.org/

Cheng, YM,Wang, ST,Chou, CY(2002).Serum CA-125 in preoperative patients at high risk for endometriosis.Obstet. Gynecol..99,375-380.

Kennedy, S.,Bergqvist, A.,Chapron, C.,D'Hooghe, T.,Dunselman, G.,Greb, R.,Hummelshoj, L.,Prentice, A.,Saridogan, E.(2005).ESHRE guideline for the diagnosis and treatment of endometriosis.Hum. Reprod..20,698-704.

Lentz, Gretchen M.,Lobo, Rogerio A.,Gershenson, David M.,Katz, Vern L.(2012).Comprehensive Gynecology.London:Elsevier Inc.

Seracchioli, R.,Mabrouk, M.,Manuzzi, L.,Vicenzi, C.,Frasca, C.,Elmakky, A.,Venturoli, S.(2009).Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptomrecurrence after conservative surgery for endometriosis.Hum. Reprod..24,27+29-35.