中医理论指导下氩氦刀控制ⅢB-Ⅳ期肺癌策略研究

发布时间：2018-04-01 04:26

本文选题：晚期肺癌　切入点：现代技术　出处：《北京中医药大学》2016年硕士论文

【摘要】：[研究背景](SCIENCE))在庆祝创刊125周年之际公布了125个最具挑战性的科学问题,第76个为肿瘤的控制比治愈是否更容易?在西医外科临床实践中：外科医生普遍认为根治性手术至今仍是唯一有可能使早期肺癌患者获得治愈的治疗方式。对于晚期肺癌,控制疾病发展,将癌症转变为慢性病进行治疗是目前的治疗大趋势。氩氦靶向消融系统(Endocare Cryocare System)自引入我国以来广泛开展,并取得良好临床效果。以中医基础理论为指导的、现代技术为手段的肿瘤治疗新模式正逐渐形成,并渐趋成熟。但运用中医理论指导氩氦刀冷冻技术更好的实现肿瘤疾病控制这一领域研究目前尚属空白。[研究目的]通过观察不同冰球覆盖率对患者生存期的影响,探讨中医基础理论与氩氦刀冷冻技术的相关性,为控制ⅢB期-Ⅳ期肺癌患者病情发展提供最佳治疗策略。[研究方法]回顾性分析2013年1月至2015年3月于东方医院肿瘤科行氩氦刀冷冻消融术的ⅢB期-Ⅳ期的74例晚期肺癌患者,通过记录一般资料、氩氦刀术中的影像学信息、患者术后生存期以及不良反应,进行统计分析,总结球覆盖率与患者生存期及安全性关系。[研究结果]1总体分析74例患者的术后中位生存期为8.4[4.3,12.6]月,冰球覆盖率70%组为8.6[3.1,14.1]月,冰球覆盖率170%组为8.3[2.9,13.6]月,差异无统计学意义(P=0.3250.05),采用COX比例风险回归模型将年龄、性别、肿瘤大小、位置、病理类型、肿瘤分期等协变量送入方程(P=0.0350.05),以冰球覆盖率分层,取协变量为均值处的生存曲线,综合多因素后,70%组可获得更长生存期,提示冰球覆盖率70%可更好控制肿瘤发展。2具体分析2.112例3cm患者生存期统计12例3cm患者中,冰球覆盖率≥70%组患者中位生存期为20.533[0,44.842]月,比74例患者的8.4[4.3,12.6]月有明显优势。2.2边缘显著资料统计肿瘤为3-5cm时,70%组有更长术后生存期,差异边缘显著P=0.086(0.05P0.1)；鳞癌组,70%组有更长术后生存期,差异边缘显著P=0.071(0.05P0.1)；腺癌组,70%组有更长术后生存期,差异边缘显著P=0.102≈0.1(0.05P≤0.1)；对于小细胞肺癌,≥70%组有更长术后生存期,差异边缘显著P=0.073(0.05P0.1)；2.3无统计差异资料统计可能由于样本量过少等因素,致使在5-7cm组、≥7cm组、周围型肺癌、中央型肺癌、ⅢB期及Ⅳ期肺癌的比较中,70%组与≥70%组无明显差异。2.4不良反应统计70%组在疼痛、发热、咳血、胸腔渗液亚组中不良反应的发生率较低,而在咳嗽、气胸亚组中的不良反应发生率较高,两组不良反应均在2周内消失。[研究结论]1、总体分析,冰球覆盖率70%组疾病控制情况优于冰球覆盖率≥70%组；2、具体分析,肿瘤3cm,冰球覆盖率多≥70%；肿瘤为3-5cm、腺癌、鳞癌患者冰球覆盖率70%组对疾病控制更理想；对于小细胞肺癌患者,冰球覆盖率≥70%组对疾病控制更理想；安全性方面：70%组较≥70%组不良反应少。3、中医基础理论讲求辩证论治,在以中医基础理论为指导下的氩氦刀冷冻微创技术在临床治疗中同理应当辩证施治,根据患者正气、邪气、病势、护场等诸多因素综合分析,最终制定合理有效治疗策略,控制疾病发展,延长患者生存期。
[Abstract]:[background] (SCIENCE)) in 125th anniversary on the occasion of celebrating the publication published the 125 most challenging scientific problems, seventy-sixth for tumor control than cure is easier? In western surgery in clinical practice: Surgeons generally believe that radical surgery remains the only possible to cure in the treatment of early stage lung cancer patients for advanced lung cancer progression, cancer will turn into chronic disease treatment is the current trend. Targeted argon helium ablation system (Endocare Cryocare System) since the introduction of China's extensive, and achieved good clinical effect. Guided by the basic theory of TCM, modern technology as a means of tumor the new treatment mode is gradually formed, and gradually mature. But the use of tumor disease control research in this field is still blank. The research direction of theory of traditional Chinese medicine cryoablation technology better The purpose of this coverage to observe the different effects of ice hockey on the survival of patients, to investigate the correlation between the TCM basic theory and technology of argon helium knife, for the control of stage B - stage lung cancer patients with the best treatment strategy. Provide methods] a retrospective analysis from January 2013 to March 2015 in the Eastern Hospital for argon helium knife cryoablation stage B / IV 74 cases of patients with advanced lung cancer, by recording the data information in the imaging of argon helium knife, and the survival of patients with postoperative adverse reactions, statistical analysis, summed up the ball coverage and patient outcomes. Research on survival and safety of the overall relationship between]1 analysis of 74 cases patients with postoperative median survival period was 8.4[4.3,12.6] months, ice hockey coverage rate of 70% group was 8.6[3.1,14.1] months, ice hockey coverage rate of 170% group was 8.3[2.9,13.6] months, there was no statistically significant difference (P=0.3250.05), using COX proportional The risk regression model of age, gender, tumor size, location, pathological type, tumor staging and other covariates into equation (P=0.0350.05), as ice hockey coverage levels, take the covariate for survival curve at mean, multiple factors, the 70% groups will be a longer survival time, suggesting that ice hockey coverage of 70% can better control the development of tumor specific.2 analysis of 2.112 cases of 3cm patients with survival statistics of 12 patients with 3cm, ice hockey coverage rate greater than 70% with a median survival time of 20.533[0,44.842] months, more than 74 patients 8.4[4.3,12.6] months have obvious advantages.2.2 marginal significant statistics tumor is 3-5cm, the 70% group had a longer postoperative survival difference the edge was P=0.086 (0.05P0.1); squamous cell carcinoma group, 70% group had a longer postoperative survival period, significant difference edge P=0.071 (0.05P0.1); adenocarcinoma group, the 70% group had a longer postoperative survival, significant P difference edge =0.102 = 0.1 (0.05P = 0.1); for Small cell lung cancer, more than 70% group had a longer postoperative survival period, significant difference edge P=0.073 (0.05P0.1) 2.3; no statistical difference statistics may be due to small sample size and other factors, resulting in the 5-7cm group, 7cm group, peripheral lung cancer, central lung cancer, compared with stage B and stage IV lung cancer. More than 70% groups and no significant difference between the 70% groups of adverse reactions.2.4 statistics of the 70% groups in pain, fever, hemoptysis, pleural fluid subgroup of adverse reactions to a low incidence of adverse reactions in cough, pneumothorax in the subgroup of higher rate of adverse reactions of the two groups were disappeared in 2 weeks. The conclusion of the study]1, general analysis, ice hockey coverage of 70% groups of disease control is better than the ice hockey coverage of more than 70% groups; 2, specific analysis, tumor 3cm, ice hockey coverage rate is not less than 70%; tumor 3-5cm, adenocarcinoma, squamous cell carcinoma patients with ice hockey coverage rate of 70% group is more ideal for disease control; for small cell lung cancer patients, Ice hockey coverage of more than 70% group is more ideal for disease control; safety: 70% groups of more than 70% with fewer side effects in the treatment of.3, the basic theory of traditional Chinese medicine emphasizes the dialectical theory of governance, in the basic theory of TCM cryoablation of minimally invasive techniques under the guidance of empathy should be dialectical therapy in the clinical treatment of patients, according to righteousness, evil the comprehensive analysis of many factors, illness, shield, and ultimately to develop reasonable and effective treatment strategies, control the development of the disease and prolong the survival of patients.

【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】：R734.2

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