探讨疏肝补肾汤联合腹腔镜手术对难治性多囊卵巢综合征（PCOS）患者的卵巢体积、血清同源框基因 A10 （HOXA10）表达及妊娠率的影响。【方法】 将80例肝郁肾虚型难治性PCOS患者随机分为观察组和对照组，每组各40例。对照 组给予常规腹腔镜手术和常规药物治疗，观察组在对照组的基础上加用疏肝补肾汤治疗，1个月经周期为1个疗程，连续治 疗 3 个疗程。观察 2 组患者治疗前后中医证候积分、卵巢体积、卵泡直径、血清 HOXA10 表达及性激素[黄体生成素（LH）、 雌二醇（E2）、孕酮（P）、促卵泡生成素（FSH）和睾酮] 水平的变化情况，以及 2 组患者随访半年的妊娠情况。【结果】（1）治 疗后，2组患者的卵巢体积均呈现不同程度的缩小（P＜0.05），卵泡直径均呈现不同程度的增加（P＜0.05），且观察组对卵巢 体积的缩小幅度及对卵泡直径的增加幅度均明显优于对照组（P＜0.01）。（2）治疗后，2组患者的LH、FSH、睾酮水平均较治 疗前明显降低（P＜0.05），HOXA10、E2、P水平均较治疗前明显升高（P＜0.05），且观察组对LH、FSH、睾酮水平的降低幅 度及对HOXA10、E2、P水平的升高幅度均明显优于对照组（P＜0.05或P＜0.01）。（3）治疗后，2组患者的月经量异常、月经 周期异常、腰膝酸软、舌质暗红、脉沉涩等各项中医证候积分及总积分均较治疗前明显降低（P＜0.05），且观察组对各项中 医证候积分及总积分的降低幅度均明显优于对照组，差异均有统计学意义（P＜0.01）。（4）观察组的妊娠率为55.00%（22/40）， 明显高于对照组的32.50%（13/40），差异有统计学意义（P＜0.05）。【结论】 疏肝补肾汤联合腹腔镜手术治疗肝郁肾虚型难治性 PCOS，可有效改善患者的卵巢功能，促进机体性激素水平恢复正常，提高HOXA10表达水平，改善患者的子宫内膜容受性， 提高患者的妊娠率。

To investigate the effects of Shugan Bushen Decoction combined with laparoscopic surgery on ovarian volume， serum homeobox gene A10（HOXA10） expression and pregnancy rate in patients with refractory polycystic ovary syndrome （PCOS）. Methods A total of 80 patients with refractory PCOS of liver stagnation and kidney deficiency type were randomly divided into an observation group and a control group，with 40 cases in each group. The control group was given conventional laparoscopic surgery and conventional medicine treatment. The observation group was treated with Shugan Bushen Decoction on the basis of treatment for the control group. One menstrual cycle constituted one course of treatment，and 3 continuous courses of treatment were given. The changes of traditional Chinese medicine（TCM） syndrome scores，ovarian volume，follicular diameter，serum HOXA10 expression and levels of sex hormones of luteinizing hormone （LH），estradiol （E2），progesterone （P）， follicle stimulating hormone（FSH） and testosterone in the two groups before and after treatment were observed. Moreover，the pregnancy outcomes of the two groups during the follow-up for half a year were monitored. Results （1） After treatment，the ovarian volume in the two groups was decreased to different degrees （P＜0.05），and the follicular diameter was increased to different degrees（P＜0.05）. The intergroup comparison showed that the decrease of ovarian volume and the increase of follicular diameter in the observation group were significantly superior to those in the control group （P＜0.01）.（2） After treatment，the levels of LH，FSH and testosterone in the two groups were significantly lower than those before treatment（P＜0.05），and the levels of HOXA10，E2 and P were significantly higher than those before treatment（P＜0.05）. The decrease of LH， FSH and testosterone levels and the increase of HOXA10，E2 and P levels in the observation group were significantly superior to those in the control group（P＜0.05 or P＜0.01）.（3）After treatment，the overall TCM syndrome scores and the scores of the syndrome manifestations of abnormal menstrual volume，abnormal menstrual cycle，soreness and weakness of waist and knees，darkish red tongue，deep and unsmooth pulse in the two groups were significantly lower than those before treatment（P＜0.05），and the decrease of overall TCM syndrome scores and the scores of each of the syndrome manifestations in the observation group was significantly superior to that in the control group， the differences being statistically significant（P＜0.01）.（4） The pregnancy rate of the observation group was 55.00% （22 / 40），which was significantly higher than that of 32.50%（13/40） in the control group，and the difference was statistically significant（P＜0.05）. Conclusion For the treatment of refractory PCOS of liver depression and kidney deficiency type，Shugan Bushen Decoction combined with laparoscopic surgery can effectively improve the ovarian function of the patients，promote the recovery of sex hormone levels，increase the expression level of HOXA10， improve the endometrial receptivity，and enhance the pregnancy rate of the patients.

R271.9

国家自然科学基金面上项目（编号：82074224）