运用“形神理论”探究胆管支架术联合中药治疗恶性肿瘤继发梗阻性黄疸患者的疗效

发布时间：2018-02-15 19:08

本文关键词： 形神理论恶性肿瘤梗阻性黄疸胆管支架术中药治疗疗效评价　出处：《辽宁中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:运用“形神理论”分析恶性肿瘤继发梗阻性黄疸患者行胆管支架术联合中药治疗后,“形”、“神”改善情况,以及对胆管支架术联合中药治疗的疗效作出相应评价。方法:选取辽宁中医药大学附属医院肿瘤科2012年10月至2014年7月期间,住院治疗的所有恶性肿瘤继发梗阻性黄疸患者的临床资料,对其资料全面整理,并严格按照纳入标准筛选,选取符合标准的患者入组。将入组患者予相应中药治疗,根据是否行胆管支架术,分为支架联合中药组和单纯中药组。运用形神理论评价两组治疗前后疗效,其中针对“形”的疗效评价包括:理化指标、生存期,针对“神”的疗效评价包括:一般状态评分和中医症状评分。结果:1.本次入组患者共36例,其中支架联合中药组15例,单纯中药组21例,其中36例(100%)患者使用了中药汤剂或中成药。原发癌类型:36例患者中,胆管癌最多,为19例,其次为肝癌5例、胰腺癌4例、胃癌4例,结肠癌3例,非霍奇金淋巴瘤1例,患者半数以上有转移。2.对“形”的评价2.1胆管支架术联合中药对比单纯中药治疗,可明显降低患者血清胆红素水平,尤其对总胆红素和直接胆红素的降低效果显著,对间接胆红素的降低效果不明显;胆管支架术联合中药治疗无法降低转氨酶水平。胆管支架术可以部分改善患者“形伤”。2.2胆管支架术联合中药治疗对延长患者生存期效果不理想。3.对“神”的评价3.1胆管支架术联合中药治疗可显著提高患者一般状态(KPS评分),明显改善患者“神”的损伤;3.2胆管支架术联合中药治疗对所有症状总缓解率为57.1%,总疗效的评价为“有效”,对比单纯中药组总缓解率33.7%,有明显优势。其中支架联合中药组各项缓解率:黄疸74.4%、腹胀77.8%、食欲不振73.1%,疗效为显效;发热50%、神疲乏力60%、腹痛42.85%、失眠33.3%、便秘50%、腹水55.5%、下肢浮肿58.3%,疗效为有效;腹泻0%、消瘦0%、尿少0%疗效为无效。结论:1.胆管支架术联合中药治疗对恶性肿瘤继发梗阻性黄疸患者的“形伤”和“神伤”均有一定缓解作用,达到形神的相对统一。2.胆管支架术联合中药治疗部分缓解患者形伤,但无法延长患者生存期。3.胆管支架术联合中药治疗可以短期内明显改善患者神伤,尤其对改善黄疸、腹胀、食欲不振效果显著。4.临床可应用胆管支架术及中药,配合放疗、化疗等手段,共同治疗恶性肿瘤继发性黄疸,以期达到最佳的远期疗效。
[Abstract]:Objective: to analyze the improvement of "shape" and "spirit" in patients with malignant tumor secondary obstructive jaundice treated by biliary stenting combined with traditional Chinese medicine. Methods: from October 2012 to July 2014, the department of oncology, affiliated hospital of Liaoning University of traditional Chinese Medicine, was selected to evaluate the curative effect of biliary stenting combined with traditional Chinese medicine. The clinical data of all patients with obstructive jaundice secondary to malignant tumor treated in hospital were comprehensively sorted out, and the patients who met the criteria were selected to be selected into the group according to the inclusion criteria. The patients in the group were treated with traditional Chinese medicine. According to whether biliary stents were performed, they were divided into two groups: stents combined with traditional Chinese medicine and traditional Chinese medicine alone. The therapeutic effects of the two groups before and after treatment were evaluated by using the theory of form and mind. The evaluation of curative effect for "shape" included: physical and chemical indexes, survival time, Results 1. There were 36 patients in this group, including 15 cases in the group of stents combined with Chinese medicine, 21 cases in the group of traditional Chinese medicine alone. Among them, 36 patients were treated with traditional Chinese medicine decoction or traditional Chinese patent medicine. Among the 36 patients with primary cancer type: the most common type was cholangiocarcinoma (19 cases), followed by liver cancer (5 cases), pancreatic cancer (4 cases), gastric cancer (4 cases), colon cancer (3 cases), and non Hodgkin's lymphoma (1 case). Evaluation of "shape" of Bile duct Stent combined with traditional Chinese Medicine alone, the serum bilirubin level was significantly decreased, especially in total bilirubin and direct bilirubin. The decrease of indirect bilirubin was not obvious. Bile duct stenting combined with traditional Chinese medicine can not reduce the level of transaminase. Bile duct stenting can partially improve the patients'"shape injury" .2.2 bile duct stenting combined with Chinese medicine treatment for prolonging the survival of patients is not ideal. 3. Evaluation of "spirit" 3.1 Bile duct stenting combined with traditional Chinese medicine can significantly improve the general state of KPS score and improve the total remission rate of all symptoms in patients with "Shen" injury-3.2 bile duct stenting combined with traditional Chinese medicine treatment (57.1%), and the evaluation of the total curative effect is as follows: " "effective", compared with the total remission rate of 33.7 in the traditional Chinese medicine group, there are obvious advantages. Among them, the relief rate of the stent combined with traditional Chinese medicine group is: jaundice 74.4, abdominal distension 77.8 and loss of appetite 73.1, the curative effect is remarkable; Fever 50, fatigue 60, abdominal pain 42.85, insomnia 33.3, constipation 50, ascites 55.5, lower limb swelling 58.3, the effect is effective; The curative effect of 0: 1. Bile duct stenting combined with traditional Chinese medicine for patients with secondary obstructive jaundice caused by malignant tumor can be alleviated to a certain extent, both "mental injury" and "mental injury" in patients with malignant tumor secondary obstructive jaundice. Reach the relative unity of form and spirit .2.Bile duct stenting combined with traditional Chinese medicine partly alleviates the patient's form injury, but cannot prolong the patient's survival time .3. Bile duct stenting combined with traditional Chinese medicine treatment can obviously improve the patient's mental injury in a short period of time, especially for improving jaundice and abdominal distension. Clinical application of bile duct stenting and traditional Chinese medicine, combined with radiotherapy, chemotherapy and other means to treat malignant tumor secondary jaundice, in order to achieve the best long-term effect.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R730.5

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