散结散合西黄胶囊降低胃息肉术后复发率的临床疗效观察

发布时间：2018-10-11 07:23

【摘要】：目的:胃息肉是胃黏膜局部隆起性病变,近年来检出率呈上升趋势,治疗原则主张发现息肉均应手术切除,尤其是切除腺瘤性息肉,来预防和减少癌变的发生。但是,由于胃息肉存在一定的复发性,大多数患有胃息肉的患者需反复进行消化道内镜下息肉切除。因此,本研究通过观察胃息肉的临床表现、病理类型及其相关性等,结合中医辨证论治,预防及治疗胃息肉,进以指导临床,降低胃息肉的复发率,从而有效降低胃恶性肿瘤的发生率,为中医治疗胃息肉提供新思路。方法:选取2015年11月至2017年2月北京中医药大学东直门医院脾胃科门诊符合纳入标准患者共67例,其中剔除12例,失访15例,最终疗效评价42例。建立胃息肉临床资料调查表,对符合纳入标准并同意参与本次调查的患者收集一般资料、胃镜结果、病理诊断结果及中医四诊资料,填写病例临床疗效观察表。根据中医整体辨证论治的原则,对符合纳入标准的患者予散结散加减合西黄胶囊治疗。散结散组成:生龙牡各15g,海蛤壳15g,胆南星6g,皂角刺10g,连翘6g(北京康仁堂药业有限公司生产的免煎颗粒,每日一剂,分2次口服)。西黄胶囊(陕西爱民药业,规格每粒装0.25g,用法用量一次4粒,一日2次),疗程3个月,观察期为1年。分别于治疗前、治疗后1年行胃镜检查;于治疗前、治疗后三个月进行症候学评分记录。观察记录患者用药前后的临床症状及严重程度评分;观察记录治疗前后胃镜检查结果及活体组织病理诊断结果。结果:在本研究中收集达到入选标准的胃息肉患者共42例,男性13例,女性29例,男女比例为1:2.23,女性患者明显多于男性,其中年龄最小34岁,最大75岁,平均年龄56.92±9.96岁,≥60岁患者多发。胃镜资料中息肉数目单发者12例,占28.6%,多发者30例,占71.4%。息肉生长部位以胃体多见,其次是胃底、胃窦。息肉形态以山田Ⅱ型(占40.5%)和山田Ⅲ型(占31%)多见。息肉直径最小0.2cm,最大1.0cm,平均直径0.42±0.19cm,其中以0.3-0.6cm为主,占81%。病理类型依次为胃底腺息肉19例(占45.2%),腺瘤性息肉2例(占4.8%),增生性息肉6例(占14.3%),炎性息肉15例(占35.7%)。在治疗结束时,中医症状积分前后比较:治疗前积分19.52±7.74,治疗后积分2.67±1.69。临床痊愈15例,占35.7%;显效20例,占47.6%,有效5例,占11.9%;无效2例,占4.8%;总有效40例,占95.2%。通过胃镜资料的统计分析发现,对42例患者经定期随访后,仅有3例患者在1年后复发,治疗总有效率为93%,复发率为7%。研究结论:1胃息肉发病以中老年人群多见,女性发病率明显高于男性;2本研究发现胃息肉以多发多见,息肉生长部位以胃体多见,其次是胃底、胃窦。息肉直径以0.3-0.6cm为主。息肉形态以山田Ⅱ型和山田Ⅲ型多见。病理类型依次以胃底腺息肉和炎性息肉为主。3散结散合西黄胶囊口服的方法,总体治疗效果显著,胃息肉切除术后的患者在经治疗后,其复发率下降。
[Abstract]:Objective: gastric polyp is a local protuberant lesion of gastric mucosa. The detection rate of gastric polyp is increasing in recent years. The principle of treatment is that the polyp should be removed by surgery, especially the adenomatous polyp, in order to prevent and reduce the occurrence of carcinogenesis. However, due to the recurrence of gastric polyps, most patients with gastric polyps need repeated endoscopic resection of gastrointestinal polyps. Therefore, by observing the clinical manifestations, pathological types and their correlation of gastric polyps, combined with TCM differentiation of symptoms and signs, the prevention and treatment of gastric polyps can guide the clinical practice and reduce the recurrence rate of gastric polyps. It can effectively reduce the incidence of gastric malignant tumors and provide a new idea for the treatment of gastric polyps. Methods: from November 2015 to February 2017, 67 patients were selected from the Department of spleen and stomach of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine, including 12 cases excluded, 15 cases lost, and 42 cases were evaluated. To establish a clinical information questionnaire for gastric polyps, to collect general information, gastroscopy results, pathological diagnosis results and four diagnostic data of TCM for patients who meet the inclusion criteria and agree to participate in this investigation, and to fill out the observation form of clinical efficacy of cases. According to the principle of syndrome differentiation and treatment of TCM, the patients who meet the inclusion criteria were treated with Sanjie Powder plus subtraction and Xihuang capsule. Sanjie Powder composition: Shenglong Peu 15g, sea clam shell 15g, Dannanxing 6g, Saphanjiao 10g, Forsythia 6g (Beijing Kangrentang Pharmaceutical Co., Ltd., one dose per day, divided into 2 oral). Xihuang capsule (Shaanxi Aimin pharmaceutical industry, specification 0.25 g per pill, usage dosage of 4 capsules once, twice a day), the course of treatment is 3 months, the observation period is 1 year. Gastroscopy was performed before treatment and 1 year after treatment, and symptom score was recorded before treatment and 3 months after treatment. The clinical symptoms and severity scores of the patients before and after treatment were observed and the results of gastroscopy and pathological diagnosis of living tissues were observed before and after treatment. Results: a total of 42 patients with gastric polyps were collected in this study, including 13 males and 29 females. The ratio of male to female was 1: 2.23. The number of female patients was significantly higher than that of male patients, the youngest 34 years old, the maximum 75 years old, the average age 56.92 卤9.96 years. More than 60 years old patients. There were 12 cases (28.6%) with single polyps and 30 cases (71.4%) with multiple polyps. Polyp growth site in the gastric body, followed by the gastric fundus, gastric antrum. The polyps were more common in Yamada 鈪，

本文编号：2263339