食管癌术后相关症状的临床特征分析及辨证中药干预的疗效观察
发布时间：2018-08-05 11:00
【摘要】：1.研究背景和目的:外科手术是食管癌的首要治疗方式,但是因为解剖位置特殊,且发病对象多见于中老年患者,术后并发症发生率高。术后并发症的发生给食管癌术后患者带来一系列不适症状,严重影响了患者生活质量的提高。目前西医在食管癌术后并发症方面没有有效的治疗方案,仅仅以对症支持治疗或者改善手术治疗方式为主。中医药参与的综合治疗是我国食管癌治疗的重要特色,既往的临床实践显示:中医药在食管癌术后阶段具有一定减轻术后并发症,促进快速康复,防止转移复发作用。本研究以食管癌术后患者为研究对象,从中医药治疗食管癌术后相关症状入手,术后以中气下陷为核心病机,以益气升陷为主要治疗大法,病证症结合法论治食管癌术后患者,通过现代统计学方法,研究食管癌术后症状的临床特征和影响食管癌术后症状的相关因素,探讨食管癌术后常见的中医证型,评价辨证中药干预治疗食管癌术后症状的临床疗效,为临床实践提供证据。2.研究内容与方法:本研究共纳入76例食管癌单纯术后治疗患者,结合食管癌术后不适症状评估表、QLQ—OES18食管癌特异模块量表及QLQ—C30肿瘤生活质量量表,通过面对面和电话随访完成调查,运用分层聚类分析法、频数分析法、斯皮尔曼法(spearman)对术后患者不适症状进行评估分析;同时对初治的食管癌术后患者30例,采取开放性临床试验方法,通过自身前后对照,观察辨证中药干预治疗后症状改善的临床疗效。3.研究结果:3.1 一般资料:共纳入76例食管癌术后患者,男性58例,占76.32%,女性18例,占23.68%,男女之比为3.22:1;患者年龄在46-81岁之间,其中55岁者20例,占 26.31%,55-65 岁者 43 例,占 56.58%,65 岁者 13 例,占 17.11%;疾病分期中Ⅰ期29例,占38.16%,Ⅱ期23例,占30.26%,Ⅲ期24例,占31.58%;病变部位中上段9例,占11.84%,中段40例,占52.63%,下段27例,占35.53%;病理类型中鳞癌51例,占67.11%,腺癌25例,占32.89%;病理分化程度中低分化19例,占25%,中分化44例,占57.89%,高分化13例,占17.11%;术后3个月48例,占63.16%,术后3-6个月18例,占23.68%,6个月10例,占13.16%;术式中经左胸后外切口食管次全切、胃食管弓上吻合术31例,占40.79%,食管次全切、结肠/空肠代食管术14例,占18.42%,内镜下食管局部病变切除术8例,占10.53%,颈、胸、腹三切口食管次全切、胃食管颈部吻合术16例,占21.05%,Ivor-Lewis手术7例,占9.21%;术前合并其他疾病37例,占48.68%,术前无其他疾病39例,占51.32%;具有吸烟史41例,占53.95%,无吸烟史35例,占46.05%;具有饮酒史49例,占49.47%,无饮酒史27例,占 35.53%;3.2术后不适症状由高到低排名前十位依次为气短、疲乏、食欲减退、异物感、口干、呃逆、反酸、吞咽疼痛、腹泻、吞咽困难;聚类分析显示:术后主要集中在2大类症状,一类是气短、疲乏、食欲减退;另一类是:呃逆、反酸、胃胀、吞咽困难、腹泻、口干、吐黏痰、声音嘶哑等;术后3个月的症状为24.28±7.15,术后3-6个月的为22.40±9.39,术后6个月为22.27±6.92;3.3食管癌术后男性患者不适症状平均积分(25.93±9.40)高于女性患者(22.29±5.63),但是二者之间无统计学差异(P0.05);术后不同分期的患者,术后不适症状平均积分由高到低依次为Ⅲ期、Ⅱ期、Ⅰ期,随着分期越晚,不适症状平均积分越高,但是不同分期之间无统计学差异(p0.05);食管癌术后不同年龄阶段的患者,随着年龄增长,术后不适症状平均积分增加,经非参数卡方检验显示各年龄阶段之间有显著统计学差异(p0.01);不同的手术方式亦是对食管癌术后的影响因素之一,内镜下食管局部病变切除术后不适症状平均积分最少(11.00±4.30),颈、胸、腹三切口食管次全切、胃食管颈部吻合术后不适症状平均积分最高(28.67±9.18),经非参数卡方检验显示不同手术方式之间存在统计学差异(p0.05);此外不同病理类型、分化程度及病变部位对术后不适症状影响不大,经过非参数卡方检验显示无统计学差异(p0.05);3.4疲乏、食欲丧失、吞咽困难、腹泻、反酸、气短与生活质量具有相关性,疲乏可以严重影响躯体功能(Rho=0.749,P0.01);3.5食管癌术后证型分布依次为气虚证(50%)、痰湿证(46.5%)、气滞证(30.26%)、阳虚证(19.74%)、阴虚证(17.11%)、血瘀证(9.21%)、热毒证(5.26%);3.6基于病、证、症三位一体的治疗理念,芪术郁灵汤辨证加减治疗后,社会功能、认知功能、情绪功能、角色功能、躯体功能较治疗前差异显著(P0.01);能够减轻疲倦、气促、失眠、食欲丧失、腹泻、吞咽困难、口干等症状(P0.05),尤其是对疲倦、气促、食欲丧失、腹泻的症状改善较为显著(P0.01),患者的总体健康状况也显著提高(P0.01)。4.研究结论:4.1食管癌术后主要存在气短、疲乏、食欲减退等核心症状;术后不适症状随时间延长而降低,但是在术后3-6月以后下降不显著;4.2年龄、手术方式是影响术后不适症状的重要因素;4.3食管癌术后的证型分布为虚实夹杂,以气虚痰湿为主;4.4芪术郁灵汤辨证加减治疗后能够提高患者的生活质量,可以提高躯体、角色、情绪、认知、社会功能及总健康状况,并能够有效改善疲倦、气促、失眠、食欲丧失、吞咽困难、口干等症状。
[Abstract]:1. research background and objective: surgical operation is the primary treatment of esophageal cancer, but because of the special anatomical location, the incidence of postoperative complications is high. The postoperative complications bring a series of discomfort symptoms to the patients after esophagus cancer surgery, which seriously affects the improvement of the quality of life of the patients. Currently, the patient's quality of life is greatly improved. There is no effective treatment for the postoperative complications of esophagus cancer, only with symptomatic support or improvement of surgical treatment. The comprehensive treatment of traditional Chinese medicine is an important feature of the treatment of esophageal cancer in our country. The previous clinical practice shows that traditional Chinese medicine can reduce postoperative complications and promote the postoperative complications of esophageal cancer. This study took the patients after esophagus cancer as the research object, starting with the treatment of the related symptoms of esophagus cancer after the operation of esophagus cancer, with the central qi depression as the core pathogenesis after the operation, the main treatment of the Qi subsidence as the major treatment, the syndrome of the disease after the operation of the esophagus cancer patients, and the study of the esophagus through the modern statistical method. The clinical features of postoperative symptoms of cancer and the related factors affecting the postoperative symptoms of esophageal cancer, explore the common TCM syndrome types after esophagus cancer surgery, evaluate the clinical efficacy of TCM syndrome differentiation in the treatment of postoperative symptoms of esophageal cancer, provide evidence and methods of evidence.2. for clinical practice: This study included 76 patients with esophageal cancer after simple surgical treatment. The postoperative discomfort assessment table, the QLQ - OES18 esophageal cancer specific module scale and the QLQ - C30 tumor quality of life scale were investigated by face-to-face and telephone follow-up. The stratified cluster analysis, frequency analysis, and Spielman method (Spearman) were used to evaluate the discomfort symptoms of the patients after the operation; at the same time, the primary esophagus was treated. 30 cases of postoperative patients were treated with open clinical trial. Through their own pre and post control, the clinical results of symptoms improvement of TCM syndrome differentiation after treatment were observed: 3.1 general data: 76 cases of esophageal cancer were included in 76 cases, 58 men, 76.32%, 18 women, 23.68%, and 3.22:1; the age of the patients was 46-81 years old. Among them, there were 20 cases of 55 years old, 43 cases of 55-65 years old, 56.58% and 17.11% in 65 years, 29 cases in stage I, 38.16% in stage I, 23 cases in stage II, accounting for 30.26% and third stage; There were 25 cases of cancer, accounting for 32.89%, 19 cases of low differentiation in pathological differentiation, 44 cases of middle differentiation, 57.89% of middle differentiation, 13 cases of high differentiation, 17.11%, 48 cases, 63.16%, 18 cases in 3 months after operation, 18 cases in 3-6 months, accounting for months, and esophagogastric anastomosis of gastroesophageal arch, esophagogastric resection, and esophagogastric anastomosis. Colon / jejunostomy was performed in 14 cases, accounting for 18.42%. Endoscopic esophagectomy was performed in 8 cases, accounting for 10.53%, cervical, thoracic and abdominal three incision subtotal esophagectomy, 16 cases of gastroesophageal neck anastomosis, 21.05% of gastroesophageal neck anastomosis, 7 cases with Ivor-Lewis operation, 9.21%, 37 cases with other diseases before operation, 48.68%, 39 cases without other diseases before operation, accounted for 51.32%; smoking history accounted for 51.32%; smoking history accounted for 41 cases. 53.95%, no smoking history of 35 cases, accounting for 46.05%, 49 cases of drinking history, 49.47%, and no history of alcohol consumption, 27 cases, accounting for 35.53%. 3.2 postoperative discomfort symptoms from high to low ranking in the first ten place were short, fatigue, appetite reduction, foreign body sensation, dry mouth, hiccup, deglutition, swallowing pain, abdominal diarrhea, dysphagia. Cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed after operation, 2 major symptoms, mainly concentrated after operation, after operation, cluster analysis showed mainly in 2 classes, diarrhea after operation, cluster analysis showed mainly concentrated in 2 major symptoms after the operation, One type is shortness of breath, fatigue and anorexia, and the other is hiccup, acid, stomach distention, dysphagia, diarrhea, dry mouth, spitting, phlegm, hoarseness, and so on; the symptoms of 3 months after operation are 24.28 + 7.15, 3-6 months after operation are 22.40 + 9.39, 6 months after operation 22.27 + 6.92; the average integral of discomfort symptoms (25.93 + 9.40) after 3.3 esophagus carcinoma (3.3) is higher than that of women. There was no statistical difference (22.29 + 5.63), but there was no statistical difference between the two (P0.05). The average integral of discomfort symptoms after the operation in different stages from high to low was in stage III, II, stage I, the higher the average integral of discomfort symptoms, but there was no statistical difference between different stages (P0.05). The average integral of discomfort symptoms increased with age, and the non parametric chi square test showed significant statistical difference between all ages (P0.01), and the different surgical methods were also one of the factors affecting the postoperative esophagectomy. The average score of discomfort symptoms after endoscopic esophagectomy was least (11 + 4.3). 0) the average integral of the three incision of the neck, the chest and the abdomen was the highest (28.67 + 9.18) after the gastroesophageal neck anastomosis. The non parametric chi square test showed that there was a statistical difference between the different surgical methods (P0.05). In addition, the different pathological types, the degree of differentiation and the lesion site had little influence on the postoperative discomfort symptoms, and the non parameter card was passed. The square test showed no statistical difference (P0.05); 3.4 fatigue, loss of appetite, dysphagia, diarrhea, anacid, shortness of breath were associated with the quality of life, fatigue could seriously affect the body function (Rho=0.749, P0.01); 3.5 after esophagus cancer, the distribution of syndrome type was Qi deficiency syndrome (50%), phlegm damp syndrome (46.5%), qi stagnation syndrome (30.26%), Yang deficiency syndrome (19.74%), yin deficiency syndrome (syndrome of deficiency syndrome) (19.74%). 17.11%), blood stasis syndrome (9.21%), heat toxic syndrome (5.26%); 3.6 based on the treatment concept of disease, syndrome, syndrome, syndrome, syndrome, syndrome differentiation and reduction treatment, the social function, cognitive function, emotional function, role function and body function are significantly different than before treatment (P0.01), and can reduce fatigue, shortness of breath, insomnia, loss of appetite, diarrhea, dysphagia, dry mouth and so on Symptoms (P0.05), especially for fatigue, shortness of breath, loss of appetite, and symptoms of diarrhea were significantly improved (P0.01), and the overall health of the patients was also significantly improved (P0.01).4. research conclusion: 4.1 after esophagus cancer, the main symptoms such as shortness of breath, fatigue, anorexia, and so on; the postoperative symptoms of discomfort decreased with time, but 3-6 months after the operation, The postoperative decline was not significant; 4.2 age, the operation mode was an important factor affecting the postoperative discomfort symptoms; 4.3 after the operation of esophageal cancer, the distribution of syndrome type was false and solid, and Qi deficiency phlegm dampness was the main factor. 4.4 Qi Yu Ling soup can improve the quality of life and can improve body, role, emotion, cognition, social function and general health condition. And can effectively improve fatigue, shortness of breath, insomnia, loss of appetite, dysphagia, dry mouth and other symptoms.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
本文编号：2165588
[Abstract]:1. research background and objective: surgical operation is the primary treatment of esophageal cancer, but because of the special anatomical location, the incidence of postoperative complications is high. The postoperative complications bring a series of discomfort symptoms to the patients after esophagus cancer surgery, which seriously affects the improvement of the quality of life of the patients. Currently, the patient's quality of life is greatly improved. There is no effective treatment for the postoperative complications of esophagus cancer, only with symptomatic support or improvement of surgical treatment. The comprehensive treatment of traditional Chinese medicine is an important feature of the treatment of esophageal cancer in our country. The previous clinical practice shows that traditional Chinese medicine can reduce postoperative complications and promote the postoperative complications of esophageal cancer. This study took the patients after esophagus cancer as the research object, starting with the treatment of the related symptoms of esophagus cancer after the operation of esophagus cancer, with the central qi depression as the core pathogenesis after the operation, the main treatment of the Qi subsidence as the major treatment, the syndrome of the disease after the operation of the esophagus cancer patients, and the study of the esophagus through the modern statistical method. The clinical features of postoperative symptoms of cancer and the related factors affecting the postoperative symptoms of esophageal cancer, explore the common TCM syndrome types after esophagus cancer surgery, evaluate the clinical efficacy of TCM syndrome differentiation in the treatment of postoperative symptoms of esophageal cancer, provide evidence and methods of evidence.2. for clinical practice: This study included 76 patients with esophageal cancer after simple surgical treatment. The postoperative discomfort assessment table, the QLQ - OES18 esophageal cancer specific module scale and the QLQ - C30 tumor quality of life scale were investigated by face-to-face and telephone follow-up. The stratified cluster analysis, frequency analysis, and Spielman method (Spearman) were used to evaluate the discomfort symptoms of the patients after the operation; at the same time, the primary esophagus was treated. 30 cases of postoperative patients were treated with open clinical trial. Through their own pre and post control, the clinical results of symptoms improvement of TCM syndrome differentiation after treatment were observed: 3.1 general data: 76 cases of esophageal cancer were included in 76 cases, 58 men, 76.32%, 18 women, 23.68%, and 3.22:1; the age of the patients was 46-81 years old. Among them, there were 20 cases of 55 years old, 43 cases of 55-65 years old, 56.58% and 17.11% in 65 years, 29 cases in stage I, 38.16% in stage I, 23 cases in stage II, accounting for 30.26% and third stage; There were 25 cases of cancer, accounting for 32.89%, 19 cases of low differentiation in pathological differentiation, 44 cases of middle differentiation, 57.89% of middle differentiation, 13 cases of high differentiation, 17.11%, 48 cases, 63.16%, 18 cases in 3 months after operation, 18 cases in 3-6 months, accounting for months, and esophagogastric anastomosis of gastroesophageal arch, esophagogastric resection, and esophagogastric anastomosis. Colon / jejunostomy was performed in 14 cases, accounting for 18.42%. Endoscopic esophagectomy was performed in 8 cases, accounting for 10.53%, cervical, thoracic and abdominal three incision subtotal esophagectomy, 16 cases of gastroesophageal neck anastomosis, 21.05% of gastroesophageal neck anastomosis, 7 cases with Ivor-Lewis operation, 9.21%, 37 cases with other diseases before operation, 48.68%, 39 cases without other diseases before operation, accounted for 51.32%; smoking history accounted for 51.32%; smoking history accounted for 41 cases. 53.95%, no smoking history of 35 cases, accounting for 46.05%, 49 cases of drinking history, 49.47%, and no history of alcohol consumption, 27 cases, accounting for 35.53%. 3.2 postoperative discomfort symptoms from high to low ranking in the first ten place were short, fatigue, appetite reduction, foreign body sensation, dry mouth, hiccup, deglutition, swallowing pain, abdominal diarrhea, dysphagia. Cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed after operation, 2 major symptoms, mainly concentrated after operation, after operation, cluster analysis showed mainly in 2 classes, diarrhea after operation, cluster analysis showed mainly concentrated in 2 major symptoms after the operation, One type is shortness of breath, fatigue and anorexia, and the other is hiccup, acid, stomach distention, dysphagia, diarrhea, dry mouth, spitting, phlegm, hoarseness, and so on; the symptoms of 3 months after operation are 24.28 + 7.15, 3-6 months after operation are 22.40 + 9.39, 6 months after operation 22.27 + 6.92; the average integral of discomfort symptoms (25.93 + 9.40) after 3.3 esophagus carcinoma (3.3) is higher than that of women. There was no statistical difference (22.29 + 5.63), but there was no statistical difference between the two (P0.05). The average integral of discomfort symptoms after the operation in different stages from high to low was in stage III, II, stage I, the higher the average integral of discomfort symptoms, but there was no statistical difference between different stages (P0.05). The average integral of discomfort symptoms increased with age, and the non parametric chi square test showed significant statistical difference between all ages (P0.01), and the different surgical methods were also one of the factors affecting the postoperative esophagectomy. The average score of discomfort symptoms after endoscopic esophagectomy was least (11 + 4.3). 0) the average integral of the three incision of the neck, the chest and the abdomen was the highest (28.67 + 9.18) after the gastroesophageal neck anastomosis. The non parametric chi square test showed that there was a statistical difference between the different surgical methods (P0.05). In addition, the different pathological types, the degree of differentiation and the lesion site had little influence on the postoperative discomfort symptoms, and the non parameter card was passed. The square test showed no statistical difference (P0.05); 3.4 fatigue, loss of appetite, dysphagia, diarrhea, anacid, shortness of breath were associated with the quality of life, fatigue could seriously affect the body function (Rho=0.749, P0.01); 3.5 after esophagus cancer, the distribution of syndrome type was Qi deficiency syndrome (50%), phlegm damp syndrome (46.5%), qi stagnation syndrome (30.26%), Yang deficiency syndrome (19.74%), yin deficiency syndrome (syndrome of deficiency syndrome) (19.74%). 17.11%), blood stasis syndrome (9.21%), heat toxic syndrome (5.26%); 3.6 based on the treatment concept of disease, syndrome, syndrome, syndrome, syndrome, syndrome differentiation and reduction treatment, the social function, cognitive function, emotional function, role function and body function are significantly different than before treatment (P0.01), and can reduce fatigue, shortness of breath, insomnia, loss of appetite, diarrhea, dysphagia, dry mouth and so on Symptoms (P0.05), especially for fatigue, shortness of breath, loss of appetite, and symptoms of diarrhea were significantly improved (P0.01), and the overall health of the patients was also significantly improved (P0.01).4. research conclusion: 4.1 after esophagus cancer, the main symptoms such as shortness of breath, fatigue, anorexia, and so on; the postoperative symptoms of discomfort decreased with time, but 3-6 months after the operation, The postoperative decline was not significant; 4.2 age, the operation mode was an important factor affecting the postoperative discomfort symptoms; 4.3 after the operation of esophageal cancer, the distribution of syndrome type was false and solid, and Qi deficiency phlegm dampness was the main factor. 4.4 Qi Yu Ling soup can improve the quality of life and can improve body, role, emotion, cognition, social function and general health condition. And can effectively improve fatigue, shortness of breath, insomnia, loss of appetite, dysphagia, dry mouth and other symptoms.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
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