NBI内镜下大肠息肉与中医证型的应证规律研究

发布时间：2018-06-18 03:56

  本文选题：大肠息肉 + 窄带成像内镜(NBI)　； 参考：《广西中医药大学》2016年硕士论文

【摘要】：目的:探讨基于窄带成像内镜(Narrow-band Imaging,NBI)技术的大肠息肉(Colorectal polyp)镜下表现,中医证型的分布特点,病理学特征及三者之间的关系,将内镜表现延伸作为中医诊疗资料,为临床应用辨证论治提供客观依据。方法:以2014年9月至2015年9月在我院脾胃病科住院及门诊就诊,符合纳入和诊断标准的病例,对经NBI内镜白光模式及病理确诊入组的100例大肠息肉患者进行中医辨证分型,观察NBI内镜下的表现,并分析其与各中医证型、病理类型之间的关系。结果:(1)大肠息肉患者中男性56例(占56%),女性44例(占44%),男女之比为1.27:l。发生部位以乙状结肠最多(发生率32%),直肠次之(发生率29%),回盲部最少(发生率3%)。临床表现以腹泻、便秘为多见。(2)NBI模式下大肠息肉以pit-Ⅰ型、pit-Ⅱ型、pit-Ⅲ型腺管开口为主;根据山田分型四种形态均有出现,山田Ⅰ型、山田Ⅱ型、山田Ⅲ型较多出现。pit-Ⅰ型腺管开口多见于山田Ⅰ型、Ⅱ型息肉;pit-Ⅱ型腺管开口多见于山田Ⅱ型、Ⅰ型息肉;pit-Ⅲ型腺管开口多见于山田Ⅲ型、Ⅱ型息肉;pit-Ⅳ型腺管开口多见于山田Ⅲ型、Ⅳ型息肉。病理分型炎性息肉与管状腺瘤为主。(3)大肠息肉腺管开口分型与性别无相关性。(4)大肠息肉的中医证候分型主要有四类:脾虚夹瘀型(占37%)、湿热瘀阻型(占34%)、气郁痰凝型(占15%)、脾肾阳虚型(占14%)。(5)大肠息肉中医舌脉诊特点,舌形以胖大舌、嫩舌为主,舌苔分布中白苔占多数,舌色以淡白舌、淡红舌为主,脉象分布主要以缓脉,沉脉为主。(6)中医证候分型与性别、息肉大小无显著差异(P0.05),与不同年龄段有显著相关性。40~49岁及50~59岁的患者以湿热瘀阻型为主,60岁以上的患者以脾虚夹瘀型为主,70岁以上的患者以脾肾阳虚证为主。(7)NBI模式下大肠息肉腺管开口分型与中医证候分型呈正相关(P0.05)。(8)中医证候与病理类型之间的关系:炎性息肉、增生性息肉、幼年性息肉多见于湿热瘀阻证,管状腺瘤多见于脾虚夹瘀证,管状绒毛状腺瘤与绒毛状腺瘤多见于脾肾阳虚证。结论:本研究提示:(1)本病患病率男性高于女性,好发部位为直肠和乙状结肠。(2)舌脉象提示大肠息肉病患者的中医病性为本虚为主,虚实夹杂,主要病理产物为湿、痰、热及瘀。(3)本病的主要中医证型分布趋势为:脾虚夹瘀型湿热瘀阻型气郁痰凝型脾肾阳虚型。(4)病理诊断与腺管开口分型之间具有高度一致性。(5)NBI模式下大肠息肉腺管开口分型与中医证候分型呈正相关,丰富中医辨证的信息量,为中医辨证论治提供参考依据。
[Abstract]:Objective: to study the features of colorectal polypypypypypypypy of large intestine polyp under narrow band imaging (NBI) technique, the distribution characteristics of TCM syndromes, pathological characteristics and the relationship among them, and to extend the endoscopic manifestations as the data of diagnosis and treatment of traditional Chinese medicine (TCM). To provide objective basis for clinical application of syndrome differentiation and treatment. Methods: from September 2014 to September 2015, 100 cases of colonic polyps diagnosed by endoscopy and pathology in our hospital were divided into two groups according to the criteria of inclusion and diagnosis. To observe the endoscopic manifestations of NBI and to analyze the relationship between NBI and TCM syndromes and pathological types. Results among the patients with colorectal polyps, 56 cases were male (56%) and 44 cases were female (44%). The ratio of male to female was 1.27: l. The most common sites were sigmoid colon (32%), rectum (29%) and ileocecal part (3 cases). The clinical manifestations were diarrhea and constipation. In the pattern of constipation, the large intestine polyps were mainly pit- 鈪，

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