消化系统恶性肿瘤术后胃肠功能紊乱的中医理论研究

发布时间：2018-06-05 15:23

本文选题：局部辨证 + 消化系统恶性肿瘤术后胃肠功能紊乱　；参考：《北京中医药大学》2014年硕士论文

【摘要】：恶性肿瘤长期处于我国疾病死亡率的前三位,其中消化系统肿瘤是最常见的恶性肿瘤,根据《2012年中国肿瘤登记年报》数据,发病率和死亡率前五位的恶性肿瘤中,消化系统恶性肿瘤各占据了其中四位。手术是治疗消化系统恶性肿瘤的重要手段之一,术后胃肠功能紊乱是消化系统恶性肿瘤术后常见并发症之一,主要包括术后胃瘫、术后麻痹性肠梗阻、术后单纯恶心呕吐和术后腹泻四个方面,其发病率较之普通腹部外科术后胃肠功能紊乱尤高。消化系统肿瘤患者术后往往还需要行化疗、放疗等后续治疗,术后及时尽早地恢复患者的胃肠功能,是进行下一步治疗的前提,而对于不进行下一步治疗的患者,术后胃肠功能也是影响其预后的重要因素。本病的发病机制尚不十分明确,目前研究认为其发生与手术导致的解剖结构改变、炎症反应、神经损伤,以及术中术后麻醉药物的运用,感染、全身营养状况、基础疾病、电解质紊乱、精神状况等因素有关。西医治疗以营养支持、减轻胃肠道负荷、药物或局部刺激调整胃肠道动力、调节肠道菌群等方法为主,但由于西医治疗时并没有根据肿瘤患者的特点将其与普通腹部外科术后患者进行区分治疗,许多消化系统恶性肿瘤术后胃肠功能紊乱的患者缺乏有效治疗。现代中医治疗本病取得了较好的临床疗效,并针对其所包含的各个疾病进行了广泛的研究,对其中医范畴、病因病机及中医治疗均形成了一定的认识,研究报道主要是对各个疾病分别进行经验总结、临床观察及实验研究等,尚未有人将各个疾病综合起来系统地进行分析总结,缺乏对疾病总结性的认识和规范性的治疗。导师左明焕教授长期致力于消化系统恶性肿瘤术后胃肠功能紊乱的治疗和研究,认识到中医对消化系统恶性肿瘤术后胃肠功能紊乱理论认识的不完善限制了临床疗效,通过对中医古籍和现代文献的研究,对其进行整理、分析、总结,并结合导师自身丰富的临床经验,对本病因病机、辨证要点以及临床治疗进行了系统的阐释。论文主要包括文献综述,文献研究和理论阐释两部分：文献综述分为两篇,一篇为消化系统恶性肿瘤术后胃肠功能紊乱的西医研究进展,总结了消化系统恶性肿瘤术后胃肠功能紊乱的西医分类,各病的发病机制、临床诊断和治疗现状。另一篇为消化系统恶性肿瘤术后胃肠功能紊乱中医研究进展,整理了消化系统恶性肿瘤术后胃肠功能紊乱的中医基本认识、病因病机、治疗方法和各医家经验,总结了现代中医药对消化系统恶性肿瘤术后胃肠功能紊乱的诊疗现状。正文部分通过对中医古代文献的研究、以及现代治法用药的统计分析,对本病的中医归属、病因病机、辨证要点及治法治则进行了系统地阐释,总结得出本病主要包括,术后胃瘫、术后麻痹性肠梗阻、术后单纯恶心呕吐和术后腹泻四个部分,分别归属于中医“痞满”、“呕吐”、“腹胀”“纳呆”“胃反”；“肠结”；“呕吐”；“腹泻”等疾病范畴。指出其病因病机主要为正气不足、脾胃虚弱,金刀所致、脏腑受损,脉络受损、气滞血瘀和肝失疏泄四个方面,而脾胃虚弱和脏腑受损为其病机关键。提出了本病的辨证关键在于区别肿瘤患者与普通外科患者、局部辨证与全身辨证等方面。并针对性地指出目前治疗术后胃瘫、术后麻痹性肠梗阻以口服汤药治疗存在刺激吻合口、增加胃肠道负荷等风险；以及目前医家一味采用攻下法治疗肿瘤患者,在其正气不足的基础上可能进一步加重正虚的不足,创新性地提出了在局部辨证的基础上以中药外治治疗为主的治疗理念,解决了全身正虚与局部邪实的治疗矛盾,并弥补了术后恶心呕吐中药治疗的空白。
[Abstract]:The digestive system tumor is one of the most common malignant tumors in our country . The digestive system tumor is one of the most common malignant tumors in the digestive system . The operation is one of the most common complications in the digestive system malignant tumor . The postoperative gastrointestinal dysfunction is one of the most common complications in the digestive system malignant tumor .

The pathogenesis of this disease is not very clear . At present , it is considered that it is related to the changes of anatomical structure , inflammatory reaction , nerve injury , basic disease , electrolyte disturbance , mental condition and so on .

Modern Chinese medicine has achieved good clinical curative effect in treating the disease , and has made extensive research on the various diseases it contains , and has formed a certain understanding of the traditional Chinese medicine category , the cause disease machine and the traditional Chinese medicine treatment .

Professor Zuo Ming - hwan , a mentor , has long been devoted to the treatment and study of gastrointestinal dysfunction after digestive system malignant tumor . It is recognized that TCM has limited clinical curative effect on the theory of gastrointestinal dysfunction after digestive system malignant tumor . Through the study of Chinese ancient books and modern literature , it organizes , analyzes and summarizes them , and combines with the abundant clinical experience of the tutor themselves , and systematically explains this disease pathogenesis , syndrome differentiation point and clinical treatment .

The thesis mainly includes literature review , literature research and theoretical interpretation .

Literature review is divided into two articles , one is the western medicine research progress of gastrointestinal dysfunction after digestive system malignant tumor , summarizes the western medicine classification of gastrointestinal dysfunction after digestive system malignant tumor , the pathogenesis , clinical diagnosis and treatment status of each disease .

The main part of this study is the study of ancient Chinese medical literature and the statistical analysis of modern medical treatment . It is concluded that this disease mainly includes four parts of traditional Chinese medicine ' fullness ' , " vomiting " , " abdominal distension " , " anorexia " and " stomach reverse " .
" Enteral junction " ;
" vomiting " ;
It points out that the pathogenesis of the disease is mainly the deficiency of vital qi , weakness of the spleen and stomach , the result of the golden knife , the damage of the zang - fu organs , the damage of the veins and collaterals , the stagnation of qi and blood stasis and the loss of the liver . The key of the differentiation of the disease is to distinguish between the tumor patients and the general surgical patients , the local syndrome differentiation and the whole body syndrome differentiation .
At present , the traditional Chinese medicine is used to treat the tumor patients by the attack method , and the deficiency of positive deficiency may be further aggravated on the basis of the deficiency of the normal qi , and the treatment principle based on the local syndrome differentiation and the external treatment of the traditional Chinese medicine is creatively put forward , so that the treatment contradiction of the whole body positive virtual and the local evil is solved , and the blank of the traditional Chinese medicine treatment for nausea and vomiting after operation is made up .
【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】：2014
【分类号】：R273

【参考文献】