婦科術後子宮頸外翻合併反覆帶下之病例分析與心得

A Case of Cervical Ectropion Complicates with Recurrent Vaginal Discharge Treated by Chinese Medicine

本病例為一位47歲女性，過去曾剖腹產及有卵巢腫瘤、子宮頸息肉接受手術切除，此外，有子宮肌瘤及子宮腺肌症、子宮頸外翻之病史。病患長年多次婦科手術後，受帶下困擾已20多年，曾接受中西藥治療，可獲得改善但仍易反覆發作。此次因壓力大，影響睡眠而誘發帶下發作，故從婦科病史探討體質特性及分析婦科手術的影響，深入探討發病誘因，中醫辨證屬肝鬱脾虛，以四逆散加減治療後，症狀獲得明顯改善。雖然中醫典籍多提及帶病以祛濕為要，本文則提出一則以理氣疏肝治療婦科手術後子宮頸外翻反覆帶下的病案，分享在治療反覆性帶下時，必須思考病機特性與手術史的干擾，藉平衡肝脾臟腑功能與增加水穀精氣而減少疾病復發，改善生活品質。

A 47-year-old woman had received the cesarean section, laparoscopic enucleation and cervical polypectomy many years ago. Additionally, she also has GYN history of myoma and adenomyosis. She was bothered by intermittent vaginal discharge after several gynecological surgery during past 20 years and symptom and sign had relieved by vaginal tablet and Chinese Medicine. This time, she suffered from recurrent vaginal discharge with vulvar itch and malodor due to stress and sleep disturbance. We investigated with gynecology constitution and diagnosed as liver depression and spleen deficiency. We administered the Si Ni San modified formula and the symptom got improved. Though the Classics of Chinese Medicine believe to dispel dampness in treating with leucorrhea, we should think about the mechanism of the disease and the effect of the surgery when treating recurrent vaginal discharge. We tried to treat a case of persistent cervical ectropion by regulate qi and sooth the liver. Thus, to balance the liver and the spleen, increase the nutrition, decrease the recurrence, and improve the quality of life.