乌梅丸加减预防大肠腺瘤内镜下切除术后复发的临床研究

发布时间：2018-03-04 17:46

本文选题：乌梅丸加减　切入点：大肠腺瘤　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的根据乌梅丸古方今用的临床经验,本课题将其用于治疗大肠腺瘤内镜下切除术后的患者,采用随机对照方法,观察中医药预防大肠腺瘤切除术后复发的疗效及患者症状的改善,并分析大肠腺瘤术后复发的影响因素,从而有效预防大肠腺瘤术后复发,提高临床疗效,为运用中医药预防大肠腺瘤术后复发提供理论依据。研究方法在我院住院患者中,选择60例符合大肠腺瘤纳入标准的患者,随机分成对照组和治疗组。经肠镜行大肠腺瘤切除术后,两组患者均给予禁食、抗感染、营养支持等常规治疗。治疗组则在对照组基础上,即于术后7天加服乌梅丸加减中药汤剂(炙乌梅30g,太子参10g,炒白术10g,炮姜5g,川连3g,煨木香10g,陈皮10g,生苡仁20g,升麻10g,炙甘草3g),脾虚,大便乏力,溏烂者,加茯苓15g,淮山药15g;阳虚,形寒怕冷,大便溏薄者,加肉豆蔻6g、诃子5g;气滞,大便不畅者,加槟榔10g、枳实10g、大黄5g;湿热内盛,口苦,苔黄腻者,加黄芩10g、煨葛根10g。按上述剂量煎煮,每日1剂,分早晚2次口服,疗程为3个月。对照组患者不作任何处理。于术后6个月复查肠镜,观察复发情况及影响复发的相关因素,如患者年龄、性别、腺瘤的部位、大小、数目、病理类型等性质,并进行临床症状改善情况的比较。研究结果术后随访,6个月后统计结果显示60例患者中复发28例,总复发率为46.7%。其中对照组复发18例,复发率为60%,治疗组复发10例,复发率为33%,经统计学检验,两组患者术后复发率存在显著差异(p0.05)。对大肠腺瘤术后复发的患者进行临床分析,复发与患者年龄、腺瘤数目、瘤变程度比较,p0.05,具有统计学意义,复发与患者性别、腺瘤大小、部位及腺瘤类型比较,p0.05,无统计学意义。术前,治疗组患者的腹痛、腹胀、便秘、腹泻、口苦、里急后重的中医症状评分与对照组比较,p0.05,差异无统计学意义,术后6个月,治疗组中医证候积分(除里急后重)与治疗前相比,p0.05,具有统计学意义,对照组中医证候积分与治疗前相比,p0.05,差异无统计学意义。研究结论利用乌梅丸加减中药辩证施治大肠腺瘤术后患者,在一定程度上可降低大肠腺瘤的术后复发率,有效改善患者腹痛、腹胀、便秘、腹泻、口苦、里急后重等中医症状、体征,促进患者恢复,且无明显不良反应。通过对术后复发的患者进行临床分析发现,复发情况与病患的年龄、腺瘤数目及瘤变程度皆有一定的相关性,与病患的性别、腺瘤的大小、部位及类型无显著相关性。
[Abstract]:Objective according to the clinical experience of Wumei Pill, we used it in the treatment of colorectal adenoma after endoscopic resection. To observe the effect of traditional Chinese medicine (TCM) on preventing recurrence of colorectal adenoma after resection and the improvement of patients' symptoms, and to analyze the influencing factors of postoperative recurrence of colorectal adenoma, so as to effectively prevent recurrence of colorectal adenoma and improve clinical curative effect. In order to provide a theoretical basis for the prevention of postoperative recurrence of colorectal adenoma with traditional Chinese medicine, 60 patients with colorectal adenoma were selected in our hospital. The patients in the two groups were treated with fasting, anti-infection, nutritional support and other routine treatments. The treatment group was based on the control group. That is, on the 7th day after operation, add and subtract traditional Chinese medicine decoction (30 g, 10 g of Radix Pseudostellariae, 10 g of Radix Pseudostellariae, 10 g of Atractylodes macrocephala, 5 g of Ginger, 3 g of Sichuan Lian, 10 g of simmer, 10 g of Old Peel, 20 g of seed seed, 10 g of Constantine, 3 g of grilled Glycyrrhiza uralensis, deficiency of spleen, weakness of large stool, loose stool, 15g of Fuling, 15g of yam, Yang deficiency, Cold cold, thin stool, 6 g nutmeg, 5g chebula, 10g areca nut, 10g Areca, 10g Aurantii, 5g rhubarb, 10g damp heat, bitter mouth, greasy moss, 10g baicalin, 10g simmer pueraria root 10g. The patients in the control group were treated with enteroscopy at 6 months after operation to observe the recurrence and related factors, such as age, sex, location, size and number of adenoma. The results showed that 28 of the 60 patients had recurrence, and the total recurrence rate was 46.7.The results showed that 18 patients in the control group were relapsed. The recurrence rate in the treatment group was 10 cases and the recurrence rate was 33%. There was a significant difference in the recurrence rate between the two groups by statistical test (p 0.05). The clinical analysis of the patients with recurrence of colorectal adenoma was made, the recurrence and age of the patients, the number of adenomas, and the number of adenomas were analyzed. There was no significant difference between recurrence and sex, size, location and type of adenoma. Before operation, abdominal pain, abdominal distension, constipation, diarrhea, bitter mouth were found in treatment group. Compared with the control group, the scores of TCM symptoms in the treatment group were significantly higher than those in the control group (P 0.05), and there was no significant difference in the scores of TCM symptoms between the treatment group and the control group. Six months after the operation, the score of TCM syndrome in the treatment group was significantly higher than that in the control group (P 0.05). In the control group, the score of TCM syndromes was not significantly different from that before treatment. Conclusion the postoperative recurrence rate of colorectal adenoma can be reduced to a certain extent by adding and subtracting traditional Chinese medicine with Wumei Pill in the treatment of colorectal adenoma. It can effectively improve the symptoms and signs of TCM, such as abdominal pain, abdominal distension, constipation, diarrhea, bitter mouth, severe internal and external symptoms, and promote the recovery of patients, and there is no obvious adverse reaction. Recurrence was correlated with age, number and degree of adenoma, but not with sex, size, location and type of adenoma.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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