作者感谢成都中医药大学附属医院妇科的温毅医生和其他医务人员的帮助。

本研究的所有程序均按照临床试验注册进行，并已获得成都中医药大学附属医院伦理委员会的批准（备案号：2021KL-004）。本研究中的所有患者都对研究者在试验期间使用数据、图像和相关视频拍摄表示知情同意。
1. 手术前的准备
<ol><li>纳入标准如下：包括符合西医盆腔炎诊断标准 8,9 和中医湿热瘀证型10 的患者，年龄 20-25 岁。</li>
	<li>设定以下排除标准： 盆腔痛或下腹痛的其他原因;过去 6 个月内怀孕、哺乳或准备怀孕;影响心脏、肝脏、肾脏和造血系统的严重疾病，使治疗无法耐受;无法或不愿合作;容易过敏或形成瘢痕疙瘩的个体;上个月有类似药物或物理治疗史。</li>
	<li>准备好以下材料：无菌手套、一次性肠线嵌入针、一次性埋线工具包（治疗托盘、无菌纱布、无菌棉签、碘伏棉签、镊子、“0”肠线、医用贴片; 图 1）。</li>
	<li>让患者仰卧，放松，充分露出腹部和下肢。</li>
	<li>检查目标穴位位置的皮肤状况，如果没有异常，请继续手术。 注意：穴位皮肤有感染、溃疡或疤痕的患者不应进行包埋。如果患者极度饥饿、疲劳或承受巨大的精神压力，则不应立即进行手术。避免对经期患者进行该程序。</li>
	<li>让医生进行常规手部消毒并戴无菌手套。</li>
	<li>检查一次性埋线针芯与针管是否配合顺畅（图 2A）。</li>
	<li>右手拿着镊子，将肠线放入针管中（图 2B）。 注意： 肠线需要完全插入针管中。</li>
</ol>2. 操作步骤
<ol><li>选择以下穴位（国际代码）：中鸡 （RN3）、观元 （RN4）、气海 （RN6）、桂来 （ST29）、自贡 （EX-CA1）、雪哈 （SP10）、祖三里 （ST36）、银灵泉 （SP9） 和三阴角 （SP6; 图 3）。</li>
	<li>进针<ol><li>用左手收紧进针部位的皮肤，用右手的拇指、食指和中指捏住针管。</li>
		<li>以 90° 角快速向下插入针头与皮肤（图 2C、D）。</li>
		<li>当患者出现酸痛、麻木、腹胀等气感（针感）时，停止插针，推动针芯，拔出针管，将肠线留在气接收区。</li>
	</ol></li>
	<li>拔针：左手按压穴皮肤，右手拔出针芯和针筒。 注意：肠线必须完全皮内，不应留在皮下或暴露在皮下注射剂外。</li>
	<li>用消毒过的干棉球压缩针孔 30 秒，并在针孔上涂抹 2 天。</li>
</ol>3. 埋入肠线后的注意事项
<ol><li>确保嵌入的部位在前 48 小时内不与水接触。</li>
	<li>建议患者在手术后 7 天内避免剧烈的体力活动，尤其是在埋线区域周围。</li>
</ol>4. 不良反应和管理
<ol><li>患者不适<ol><li>疼痛<ol><li>告诉患者疼痛是一种常见的不良反应11 并且他们的疼痛会在 5-7 天后大部分消失。</li>
			<li>在手术过程中使用细线嵌入针和肠线体。</li>
			<li>对于对疼痛敏感且没有已知禁忌症的患者，考虑术前口服镇痛药11;如有必要，在嵌入肠线12 之前用利多卡因进行局部麻醉。</li>
		</ol></li>
		<li>针头相关性昏厥 注意：这是指在穴位埋肠治疗期间突然出现头晕、视力模糊、心悸、恶心甚至晕厥。<ol><li>如果患者晕倒，请立即停止肠线嵌入并观察患者的生命体征。对于较轻的情况，请患者躺下一会儿，喝温水或喝含糖饮料。在症状没有缓解的情况下，采用现代急救措施。</li>
		</ol></li>
		<li>出血或局部血肿<ol><li>如果包埋部位出现术后出血，请用干棉签轻轻按压局部部位以止血。</li>
			<li>如果形成血肿，请在 24 小时内进行冷敷，然后在 24 小时后进行热敷以促进血肿吸收。 注意：如果出血持续或大量出血，则可能表明血管损伤，需要手术干预。</li>
		</ol></li>
	</ol></li>
	<li>肠体排斥反应<ol><li>发烧 注意：任何发烧通常会在 1 周内消失。<ol><li>指导患者多喝水。用物理降温或口服解热药治疗持续发热。</li>
			<li>当出现长时间的高热时，请确保外科专家及时冷却并去除嵌入的肠线。</li>
		</ol></li>
		<li>过敏反应<ol><li>寻找过敏症状，例如局部发红、皮疹和瘙痒;提供抗组胺药（如马来酸氯苯那敏、西替利嗪、氯雷他定）或皮质类固醇（如地塞米松）进行过敏管理，必要时从体内清除包埋的肠线。</li>
		</ol></li>
		<li>结节或肿块<ol><li>小结节通常会自行消退。对于局部坚硬的肿块，采用艾灸和穴位注射等方法13。</li>
		</ol></li>
		<li>线程溢出<ol><li>通过修剪或提取挤出的肠线，然后重新嵌入来管理线程溢出。</li>
		</ol></li>
		<li>感染<ol><li>在肠线包埋后的前 5 天内，局部部位可能会出现不同程度的炎症。如果包埋部位有过多分泌物或有脓性变化的迹象，请使用抗生素治疗以控制感染。如有必要，寻求手术干预。</li>
		</ol></li>
	</ol></li>
</ol>5. 观察指标
<ol><li>临床疗效评价14<ol><li>将恢复定义为所有相关症状和体征（如盆腔疼痛）的改善，评分下降 ≥95%。</li>
		<li>将显著效应定义为 70% ≤分数降低< 95%。</li>
		<li>如果 30% ≤评分降低< 70%，则认为治疗有效。</li>
		<li>如果分数降低 <30%，则认为治疗无效。</li>
	</ol></li>
	<li>使用简化的麦吉尔疼痛量表 （SF-MPQ）15 来评估治疗前后的疼痛情绪和严重程度，分数越高表示疼痛越严重。</li>
	<li>使用中医湿热瘀滞证量表对中医证16 分进行评分。分数越高，症状越严重。</li>
	<li>使用盆腔体征量表17 评估治疗前后的腹部压痛或反弹痛、子宫压痛、颈部抬高和摆动痛以及附件压痛。分数越高，骨盆疼痛越严重。</li>
	<li>使用世界卫生组织生活质量 （WHOQOL） - BREF 量表18 对患者的生存质量进行评分，并积极计算领域分数，这意味着分数越高，生活质量越好。</li>
</ol>6. 统计分析
<ol><li>将符合正态分布的测量数据表示为平均值±标准差 （SD）。</li>
	<li>使用独立样本 t 检验进行组比较，使用配对样本 t 检验进行治疗前后的比较。</li>
	<li>将不符合正态分布的数据表示为 M （25%，75%）。</li>
	<li>使用秩和检验进行组比较，并使用配对秩和检验进行治疗前后的比较。</li>
	<li>将计数或序数数据表示为分量比率。</li>
	<li>使用 Fisher 精确概率法或卡方检验执行组比较。</li>
	<li>对前后控制使用配对设计 t 检验。进行双侧假设检验至 α= 0.05;认为 P < 0.05 具有统计学意义。</li>
</ol>

穴位肠埋入术治疗慢性盆腔疼痛

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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+observation+of+chronic+pelvic+inflammation+of+different+differentiated+patterns/syndromes+treated+with+acupoint+embedding+therapy.">Efficacy observation of chronic pelvic inflammation of different differentiated patterns/syndromes treated with acupoint embedding therapy.</a> Zhongguo Zhen Jiu. 32 (12), 1081-1083 (2012).</li><li>Huang, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+the+cost+of+chronic+pelvic+pain+in+women.">A systematic review of the cost of chronic pelvic pain in women.</a> J Obstet Gynaecol Can. 44 (3), 286-293 (2022).</li><li>Wang, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+adverse+reactions+of+acupoint+catgut+embedding+therapy.">Analysis of adverse reactions of acupoint catgut embedding therapy.</a> Zhongguo Zhen Jiu. 40 (2), 193-196 (2020).</li><li>Xue, H. Q., Ma, L., Zhang, Y. Q., Shi, X. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+the+selection+pattern+of+acupuncture+points+for+chronic+pelvic+pain+in+the+sequelae+of+pelvic+inflammatory+diseases+[J].">Analysis of the selection pattern of acupuncture points for chronic pelvic pain in the sequelae of pelvic inflammatory diseases [J].</a> Guangming Traditional Chinese Medicine. 38 (15), 2950-2953 (2023).</li><li>Wu, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+electroacupuncture+on+pain+threshold+and+expression+of+pain-related+factors+cyclooxygenase-2,+prostaglandin+E2+and+&#946;-endorphin+in+rats+with+chronic+pelvic+pain+syndrome.">Effect of electroacupuncture on pain threshold and expression of pain-related factors cyclooxygenase-2, prostaglandin E2 and &#946;-endorphin in rats with chronic pelvic pain syndrome.</a> Zhen Ci Yan Jiu. 47 (6), 531-536 (2022).</li><li>Liu, Y. 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作者声明他们没有利益冲突。

古代中医书籍中没有慢性盆腔痛的记载，根据其症状特点，可与“腹痛”、“女性腹痛”、“月经腹痛”等疾病相互参照。根据中医理论，当血管张开时，护理不当可能会导致病原因子的侵袭，如湿热，这些病原因素会在子宫及其通道中停滞，导致病原因素与健康能量的斗争，表现为盆腔炎性疾病。如果盆腔炎性疾病未经治疗或治疗不当，病情可能会持续存在并发展为盆腔炎性疾病的后遗症。盆?...

慢性盆腔疼痛 （CPP） 是指持续 6 个月以上的盆腔疼痛，是非周期性的，并且对非阿片类药物无反应。最新研究表明，CPP 的全球发病率为 ~5%-26%1。序贯盆腔炎 （SPID） 是导致 CPP 的主要疾病之一，占女性所有慢性盆腔疼痛病例的 23%-30%2。由于现有镇痛药在缓解这种疼痛方面的疗效有限，超过 50% 的 CPP 患者可能会寻求非药物治疗3。目前，主要的非药物治疗包括盆底物理治疗、心理治疗、神经调节和饮食治疗。然而，它们也有局限性，例如疼痛缓解效果不佳和难以实现长期控制。大多数患有 CPP 的 SPID 女性会因反复发作的疼痛而感到焦虑、抑郁和生活质量下降4。因此，寻找一种能够缓解患者疼痛症状的有效治疗方法已成为临床上迫切关注的问题。
针灸是中医中两种主要的外用治疗方法，在治疗与疼痛相关的疾病方面显示出良好的疗效，并已广泛用于临床实践，特别是在缓解慢性疼痛方面，它们的有效性超过了其他非药物治疗 CPP 5,6.在一项关于中医治疗 CPP 的横断面研究中，7.63% 的慢性疼痛患者被选择接受针灸治疗，治疗效果极佳7。本文介绍的穴位肠埋植法是针灸法的延伸和发展。是指使用专门设计的一次性医疗器械，将可吸收的肠线植入相应的穴位，提供持久持续的穴位刺激，达到镇痛效果的一种中医外治技术。作者的团队利用这项技术治疗由 SPID 引起的女性复发性和无法治愈的盆腔疼痛，并产生了积极的结果。它既可以作为独立治疗，也可以作为综合中医治疗计划的重要组成部分或中西医结合。本文以最常见的中医证候（湿热瘀型）SPID 患者为例，对穴位肠埋设程序进行详细演示。

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			<td>disposable catgut embedding needles</td>
			<td>Yangzhou Junbang Technology Development Co., Ltd</td>
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			<td>disposable thread embedding kit</td>
			<td>Shangdong Weigao Ruixin Medical Technology Co.,Ltd.</td>
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			<td>statistical analysis software&#160;</td>
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			<td>sterile gloves</td>
			<td>Fitone Latex Products Co.,Ltd Guangdong.</td>
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acupoint catgut embedding for treatment of chronic pelvic pain due to the sequelae of pelvic inflammatory disease

炎症性盆腔疾病后遗症引起的慢性盆腔疼痛是女性盆腔疼痛的常见临床病症。目前，其治疗面临的主要挑战是缓解疼痛的效果有限，症状频繁复发，严重影响患者的生活质量，给患者带来相当大的心理负担。这是一种临床上具有挑战性的疾病。在总结多年的治疗经验后，作者的团队发现，穴位肠线包埋在治疗盆腔炎后遗症引起的慢性盆腔痛方面显示出显著的临床疗效。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。本文为将可吸收肠线嵌入患者穴位治疗女性盆腔炎后遗症引起的慢性盆腔痛提供了全面的指南。

Chronic pelvic pain (CPP) refers to pelvic pain that persists for over 6 months, is non-periodic, and is unresponsive to non-opioid drugs. The latest research shows that the global incidence rate of CPP is ~5%-26%1. Sequential pelvic inflammatory disease (SPID) is one of the main conditions causing CPP, accounting for 23%-30% of all cases of chronic pelvic pain in females2. Due to the limited efficacy of existing analgesics in alleviating this pain, over 50% of CPP patients may seek non-pharmacological treatment3. Currently, the main non-pharmacological treatments include pelvic floor physical therapy, psychological therapy, neuroregulation, and dietotherapy. However, they also have limitations, such as suboptimal pain relief and difficulties in achieving long-term control. Most SPID women with CPP experience anxiety, depression, and decreased quality of life due to recurrent pain4. Therefore, finding an effective treatment method that can alleviate patients' pain symptoms has become a pressing clinical concern.
Acupuncture and moxibustion, two of the main external therapeutic methods in traditional Chinese medicine, have shown good efficacy in treating pain-related conditions and have been widely used in clinical practice, especially in the relief of chronic pain, where their effectiveness surpasses other non-pharmacological treatments for CPP5,6. In a cross-sectional study on the treatment of CPP with traditional Chinese medicine, 7.63% of chronic pain patients were chosen to receive acupuncture and moxibustion treatment, resulting in excellent therapeutic outcomes7. The acupoint catgut embedding introduced in this article is an extension and development of acupuncture and moxibustion. It refers to a traditional Chinese medicine external treatment technique that uses specially designed disposable medical devices to implant absorbable catgut into corresponding acupoints, providing prolonged and continuous acupoint stimulation to achieve analgesic effect. The author's team has employed this technology to treat recurrent and incurable pelvic pain in women caused by SPID, yielding positive outcomes. It can be utilized either as a standalone treatment or as an important component of a comprehensive traditional Chinese medicine treatment plan or a combination of traditional Chinese and Western medicine. This article takes the most common traditional Chinese medicine syndrome (dampness heat stasis type) patients with SPID as an example to provide a detailed demonstration of the procedures for acupoint catgut embedding.

作者聚焦：通过穴位肠埋法增强女性慢性盆腔疼痛管理

穴位肠埋葬治疗盆腔炎后遗症引起的慢性盆腔痛

Our research focuses on developing effective treatments for chronic pelvic pain due to the sequelae of pelvic inflammatory disease. Our study found that acupuncture point can improve patients'clinical symptoms and quality of life. Compared to existing Western medicine treatment methods, acupoint catgut embedding offers advantages such as a good analgesic effect, lower recurrence rate, economic benefits, and a relatively straightforward procedure.We will focus on the efficacy of external Chinese medicine for the relief of chronic pelvic pain in women and the developments of treatments protocols.

在这项临床研究中，最初共招募了 88 名参与者，其中 8 名退出（4 名来自治疗组，4 名来自另一名）。其余 80 名参与者使用随机数字表分为治疗组和对照组，每组 40 名参与者。治疗过程包括每 10 天埋入肠线一次，避免月经，连续持续 3 个月。治疗组患者也每天服用一剂中药，月经期间停药，连续 3 个月。使用的口服中草药是四泥苗石小散的改良配方，包括以下成分： 醋北柴湖 10 克、 ?...

Read this Scientific Article Protocol about Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease at JoVE.com

本文概述了穴位肠埋葬疗法治疗盆腔炎性疾病后遗症引起的慢性盆腔痛。

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main ...

我们的研究重点是开发有效的治疗方法，治疗盆腔炎后遗症引起的慢性盆腔疼痛。我们的研究发现，穴位可以改善患者的临床症状和生活质量。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。我们将重点研究外用中药缓解女性慢性盆腔疼痛的疗效以及治疗方案的发展。

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Research

JoVE Journal

Medicine

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain Due to the Sequelae of Pelvic Inflammatory Disease

315 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是开发有效的治疗方法，治疗盆腔炎后遗症引起的慢性盆腔疼痛。我们的研究发现，穴位可以改善患者的临床症状和生活质量。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。我们将重点研究外用中药缓解女性慢性盆腔疼痛的疗效以及治疗方案的发展。