【作者】 向凤茗；

【导师】 吴勉华；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2009， 博士

【摘要】 目的:观察补肝气法治疗原发性肝癌介入术后的临床疗效,探讨中药治疗本病的疗效优势及机制,为肝癌的中医临床诊治提供新的思路。方法:选取80例原发性肝癌的患者。随机分为治疗组和对照组,其中治疗组40例,对照组40例。两组患者均给予西医治疗,包括手术加介入治疗或单纯介入治疗,以及介入治疗后的对症治疗。治疗组在介入术后再加用补肝气法中药治疗3月。观察两组患者治疗前后实体瘤客观疗效、卡式评分、生活质量评分、中医症候评分、肿瘤免疫指标、肝功能、血常规,并作统计学处理。结果:两组在性别、年龄、分期、治疗前KPS积分、生活质量、中医症候积分等方面比较均无显著性差异(p＞0.05)。按照疗效评定标准,经统计学处理后,在实体瘤客观疗效方面,治疗组总有效率80%,对照组总有效率72.5%,经x~2检验,两组无显著性差异(p＞0.05),两组实体瘤客观疗效无差异。卡式评分比较,治疗组及对照组治疗前后均有显著差异(p＜0.05),组间比较无显著性差异(p＞0.05)。在肿瘤病人生活质量QOL评分积分及中医症候积分方面比较,治疗组均优于对照组(p＜0.05),其中生活质量QOL评分积分比较,两组患者自身治疗前后生活质量QOL评分均有改善,经t检验,治疗组具有极显著差异(p＜0.01),对照组有显著性差异(p＜0.05),组间比较具有显著性差异(p＜0.05),治疗组优于对照组。中医症候疗效比较,治疗组总有效率80%,对照组总有效率32.5%,经x~2检验有显著性差异,治疗组优于对照组,中医症侯积分比较,两组患者自身治疗前后比较经t检验,治疗组具有极显著性差异(p＜0.01),对照组无显著性差异(p＞0.05),组间比较具有显著性差异(p＜0.05),治疗组优于对照组。两组患者治疗后症状均有改善,但治疗组改善的症状多于对照组,尤其是口干口苦及腰酸的改善治疗组优于对照组。AFP变化情况比较,治疗后AFP下降至正常的,治疗组有13例,对照组有3例,下降但未达正常的,治疗组有24例,对照组有16例,升高的治疗组有3例,对照组有19例,两组有显著性差异(p＜0.05)。肝功能、血常规方面两组无显著差异。结论:补肝气法治疗原发性肝癌介入术后的患者,能显著改善患者因原发性肝癌而行抗癌治疗所致的各种症状,不仅减轻了手术、介入治疗的毒副作用,为继续抗癌治疗提供时机,同时也保护了脏器功能,提高患者的生活质量,使得患者能够获得较长时期带瘤生存,这说明补肝气法中药联合介入治疗原发性肝癌,能够起到相加协同作用,能够起到减毒增效的作用,能够保护和提高机体的免疫功能。从而进一步证实了肝气虚理论的合理性、客观性及补肝气法的实用性,值得临床应用和推广。更多还原

【Abstract】 Objective: To investigate and compare the clinical effect on Primary Liver Cancer(PLC) after transcatheter hepatic arterial chemoembolization(TACE) treated by Modified Buganqi Method with western medicine, in order to provide a new way for further diagnosis and improvement of TCM treatment.Methods: 80 cases of PLC, were randomly divided into two group, 40 cases in control group, using western medicine (basic therapy) including the integration of operation and TACE, simple TACE and symptomatic treatment; 40 cases in treatment group by Modified Buganqi Method. Comparisons of are carried out after 3 months on effectiveness in tumor size reduction, Karnofsky functional status, quality of life, relevant clinical parameters of TCM before and after treatment.Results: There are no statistically differences in age, sex, stage of diseases, tumor size reduction, Karnofsky functional status, quality of life, and relevant clinical parameters of TCM between two groups. (P>0.05) . According to therapeutic effect evaluation standard, the effectiveness of tumor size reduction is 80% as compared to control group (72.5%). Both groups have significantly improved in Karnofsky functional status (P < 0.05). The treatment group is superior to control group in quality of life and clinical parameters of TCM (P < 0.05). There are more symptoms being relieved in treatment group than control group, such as dry mouth and backache. The treatment has a vast significant on the decrease of alpha fetoprotein. There are no differences in relevant clinical parameters in tumor immunity, liver function and blood routine tests between two groups.Conclusions: Taking modified Buganqi Method on PLC following TACE can significantly improve the quality of life, and alleviate the clinical symptoms of the patients. This indicates the relevance of the theory of liver-qi xu is rational and objective. It is recommended to be implemented.更多还原