大肠癌患者术后排便功能异常的临床特征及辨证中药干预的疗效观察

发布时间：2018-08-03 11:18

【摘要】：研究目的：大肠癌是最常见的恶性肿瘤之一,主要包括结肠癌和直肠癌。其发病率在我国逐年升高,手术治疗目前仍是根治的唯一有效手段,近年来根治性保肛手术的应用逐渐增加,有助于延长患者生存期,提高患者生活质量。然而,随之而来的排便功能损害导致的一系列以便秘、排便费力、排便次数增多、排便急迫感、排便不尽感、腹泻及失禁等为主的临床症状严重影响患者社会生活和精神心理状态,给患者的日常生活带来很大困扰。削弱了患者对自身健康状态恢复的信心,降低了后续治疗的配合度和适应力。现代医学对此类情况关注较少,多以“前切除综合征”进行研究和治疗,但干预手段及疗效有限,中医药治疗发挥了不可替代的作用。既往的研究表明,中医药在治疗此类情况具有一定疗效,本研究从中药干预肠癌术后患者排便功能异常的疗效及其临床特征观察入手,以余毒未清、正气虚损、气机失调为核心病机,以扶正解毒、调畅气机为基本治法,辨病、辨证、辨症相结合综合论治此类患者,结合国际公认的问卷量表对其排便相关症状、排便功能、生活质量三个方面进行较为全面系统的观察、评价,为中医药改善肠癌术后患者排便功能提供理论依据和临床指导。研究方法：以大肠癌保肛根治术后出现排便异常相关症状的患者为研究对象,通过问卷及国际公认的LARSS量表、QLQ-C30、QLQ-CR38生活质量量表等采集相应临床资料,使用SPSS21.0统计软件进行频数分布、卡方检验、非参数秩和检验等统计分析。研究结果：1.一般资料：共纳入67例大肠癌行保肛根治术后的患者,男女比例41：26,平均年龄54.97±12.42岁。高龄组(65岁以上)者14例,65岁以下53例。其中结肠癌患者35例,直肠癌患者32例,术后病理性质均为腺癌,分化程度以中分化40例最多,并有低分化6例、中低分化4例、高分化11例、中高分化6例。为方便观察放化疗对患者排便症状的影响,依据患者入组时所处的西医治疗阶段将67例患者分为放化疗后32例、放化疗中17例,和未行放化疗18例三组。依据患者Bristol排便性状评分将患者分为便秘型17例,腹泻型48例,交替型2例。2.临床特征：对67例患者的排便相关症状进行分析,大肠患者术后不仅会出现腹泻、便秘,其发生排便急迫感、排便后不尽感等自感症状的频率高于便质异常；直肠癌患者发生排便急迫感、便意感、肛门下坠感三个症状的频率较高,而结肠癌患者亦会出现腹泻、便秘、排便费力、排便后不尽感、肛门直肠疼痛等排便功能损害的症状。便秘型的患者多伴有排便费力,而排便急迫感、便意感、排便后不尽感、肛门下坠感、肛门直肠疼痛这5项症状于腹泻型、便秘型患者之间发生率未见明显差异。正处在放化疗中的患者较多出现便秘和肛门直肠疼痛的症状,而较少出现腹泻。对67例患者中医证型进行统计,以气虚证、阳虚证、痰湿证、气滞证、热毒证出现频率较高。3.疗效评价：在辨证中药治疗3个月后,67例患者大便性状有显著改善,排便次数趋近于正常的1次/日,排便相关症状有显著改善,患者对排便过程的满意度有显著提高。67例患者LARSS量表评分由轻度ARS转变为无ARS的患者有10例,由重度转变为轻度的有16例,由重度转变为无的有21例,降级明显,提示其LARSS相关症状明显减轻。67例患者辨证中药治疗3个月后癌症总生活质量量表QLQ-C30相应躯体、角色、情绪、认知、社会功能评分显著提高,疲乏症状评分较前显著降低,疼痛、恶心、呕吐、呼吸困难、失眠、食欲丧失、便秘、腹泻、经济困难等症状减少,总体健康状况改善明显。治疗后肠癌患者生活质量量表QLQ-CR38相应排尿功能、排便功能、认知功能评分明显提高,胃肠癌相关症状及放化疗副反应等症状评分显著降低。结论：1.大肠癌行保肛根治术后的患者常出现排便急迫感、排便后不尽感、腹泻、便意感、排便费力、肛门下坠感、便秘、肛门直肠疼痛等不适症状,严重影响患者的术后康复、生活质量及后续治疗。其中,直肠癌患者以排便急迫感、便意感、肛门下坠感尤为多见。2.大肠癌行保肛根治术后出现排便功能异常的患者常见气虚证、阳虚证、痰湿证、气滞证、热毒证,中医药治疗以余毒未清、正气虚损、气机失调为核心病机,以扶正解毒、调畅气机为基本治法,辨病、辨证、辨症相结合综合论治。3.中医药辨治能显著改善大肠癌术后患者出现的一系列排便异常症状,提高患者的生活质量。
[Abstract]:Research objectives: colorectal cancer is one of the most common malignant tumors, mainly including colon and rectal cancer. The incidence of colorectal cancer is increasing year by year in China. Surgical treatment is still the only effective means of radical cure. In recent years, the application of radical anal preserving surgery is increasing gradually, which helps to prolong the life of the patients and improve the quality of life of the patients. The clinical symptoms of constipation, defecation, defecation, defecation, defecation, defecation, diarrhea and incontinence seriously affect the social life and mental state of the patient, and bring great distress to the daily life of the patients. Confidence has reduced the coordination and adaptability of follow-up treatment. Modern medicine pays less attention to this kind of situation, and studies and treats more with "anterior resection syndrome", but the intervention means and curative effect are limited. Traditional Chinese medicine has played an irreplaceable role. From the observation of the curative effect and clinical characteristics of the intervention of the patients with bowel cancer after the operation of traditional Chinese medicine, the clinical features of the patients with abnormal function of defecation after the operation of colon cancer were observed. A comprehensive and systematic observation on symptoms, defecation function and quality of life is carried out in three aspects. It provides a theoretical basis and clinical guidance for Chinese medicine to improve the defecation function of patients after operation of colon cancer. The LARSS, QLQ-C30, QLQ-CR38 quality of life scale and other clinical data were collected, and the statistical analysis of frequency distribution, chi square test, nonparametric rank and test was carried out by SPSS21.0 statistical software. 1. general data: the total of 67 cases of colorectal cancer after radical resection were included, the proportion of men and women was 41:26, the average age was 54.97 + 12. .42 years old (65 years of age) 14 cases, 53 cases under 65 years of age, of which 35 cases of colon cancer, 32 cases of rectal cancer, postoperative pathological properties are adenocarcinoma, differentiation degree to 40 cases of differentiation, 6 cases of low differentiation, moderate and low differentiation of 4 cases, 11 cases of high differentiation, and 6 cases of middle and high differentiation, to observe the effect of radiotherapy and chemotherapy on patient defecation symptoms, depending on the convenience of observation and chemotherapy. According to the Western medical treatment stage, 67 patients were divided into 32 cases after radiotherapy and chemotherapy, 17 in radiotherapy and chemotherapy and 18 in three groups without chemotherapy. According to the patient's Bristol defecation score, the patients were divided into 17 cases of constipation, 48 cases of diarrhoea and 2 cases of alternate type: analysis of bowel related symptoms in 67 patients, large intestine After the operation, the patient not only has diarrhea, constipation, its occurrence of defecation, and the frequency of self feeling symptoms after defecation is higher than that of stool; the frequency of three symptoms of rectal cancer patients has a sense of urgency, meaning, anus falling feeling, and the patients with colon cancer also have diarrhea, constipation, defecation, anus after defecation. The symptoms of defecation dysfunction such as pain in the rectum and other symptoms. The constipation patients are often accompanied by defecation and defecation, and there are 5 symptoms in the patients with diarrhea and constipation. The incidence of constipation and anus in patients undergoing chemotherapy is more than that of constipation and anus. The symptoms of the pain of the portal rectum were less than the diarrhea. 67 cases of TCM syndrome types were counted, with Qi deficiency syndrome, Yang deficiency syndrome, phlegm damp syndrome, qi stagnation syndrome and high frequency of heat toxic syndrome in.3.. After 3 months of TCM treatment, 67 patients had significant improvement in stool characters, the number of defecation was nearly 1 times / day, defecation related symptoms The patient's satisfaction with the process of defecation was significantly improved. The LARSS scale of.67 patients changed from mild ARS to no ARS in 10 cases, from severe to mild 16 cases, from severe change to no one in 21 cases, the lower grade was obvious, suggesting that the LARSS related symptoms of.67 patients were obviously alleviated by TCM treatment for 3 months. The post cancer total quality of life scale (QLQ-C30) related body, role, emotion, cognition, social function score improved significantly, the score of fatigue symptoms decreased significantly, pain, nausea, vomiting, dyspnea, insomnia, loss of appetite, constipation, diarrhea, economic difficulties and other symptoms, and the quality of health improved obviously. The quality of life of the patients with colon cancer after treatment. The corresponding urinary function, defecation function, cognitive function score improved significantly, and the score of the symptoms of gastric cancer and chemotherapy and chemotherapy side effects decreased significantly. Conclusion: 1. large bowel cancer patients after radical resection of the 1. colon cancer patients often have a sense of urgency, after defecation, diarrhea, stool, defecation, anus feeling, constipation, anus. The symptoms of malaise, such as the pain of the rectum, seriously affect the postoperative rehabilitation, the quality of life and the follow-up treatment. Among them, the patients with rectal cancer are particularly sensitive to bowel movement, sense of defecation, sense of meaning, and anus falling feeling especially in.2. colorectal cancer patients with abnormal bowel movement after radical operation, Yang deficiency syndrome, phlegm dampness syndrome, qi stagnation syndrome, heat toxin syndrome, traditional Chinese Medicine In the treatment of medicine, the treatment of.3. can significantly improve a series of abnormal symptoms of defecation and improve the quality of life of the patients after the operation of large intestine cancer.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.34

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