大腸癌患者術(shù)后排便功能異常的臨床特征及辨證中藥干預(yù)的療效觀察
發(fā)布時(shí)間：2018-08-03 11:18
【摘要】：研究目的：大腸癌是最常見的惡性腫瘤之一,主要包括結(jié)腸癌和直腸癌。其發(fā)病率在我國(guó)逐年升高,手術(shù)治療目前仍是根治的唯一有效手段,近年來(lái)根治性保肛手術(shù)的應(yīng)用逐漸增加,有助于延長(zhǎng)患者生存期,提高患者生活質(zhì)量。然而,隨之而來(lái)的排便功能損害導(dǎo)致的一系列以便秘、排便費(fèi)力、排便次數(shù)增多、排便急迫感、排便不盡感、腹瀉及失禁等為主的臨床癥狀嚴(yán)重影響患者社會(huì)生活和精神心理狀態(tài),給患者的日常生活帶來(lái)很大困擾。削弱了患者對(duì)自身健康狀態(tài)恢復(fù)的信心,降低了后續(xù)治療的配合度和適應(yīng)力�，F(xiàn)代醫(yī)學(xué)對(duì)此類情況關(guān)注較少,多以“前切除綜合征”進(jìn)行研究和治療,但干預(yù)手段及療效有限,中醫(yī)藥治療發(fā)揮了不可替代的作用。既往的研究表明,中醫(yī)藥在治療此類情況具有一定療效,本研究從中藥干預(yù)腸癌術(shù)后患者排便功能異常的療效及其臨床特征觀察入手,以余毒未清、正氣虛損、氣機(jī)失調(diào)為核心病機(jī),以扶正解毒、調(diào)暢氣機(jī)為基本治法,辨病、辨證、辨癥相結(jié)合綜合論治此類患者,結(jié)合國(guó)際公認(rèn)的問卷量表對(duì)其排便相關(guān)癥狀、排便功能、生活質(zhì)量三個(gè)方面進(jìn)行較為全面系統(tǒng)的觀察、評(píng)價(jià),為中醫(yī)藥改善腸癌術(shù)后患者排便功能提供理論依據(jù)和臨床指導(dǎo)。研究方法：以大腸癌保肛根治術(shù)后出現(xiàn)排便異常相關(guān)癥狀的患者為研究對(duì)象,通過(guò)問卷及國(guó)際公認(rèn)的LARSS量表、QLQ-C30、QLQ-CR38生活質(zhì)量量表等采集相應(yīng)臨床資料,使用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行頻數(shù)分布、卡方檢驗(yàn)、非參數(shù)秩和檢驗(yàn)等統(tǒng)計(jì)分析。研究結(jié)果：1.一般資料：共納入67例大腸癌行保肛根治術(shù)后的患者,男女比例41：26,平均年齡54.97±12.42歲。高齡組(65歲以上)者14例,65歲以下53例。其中結(jié)腸癌患者35例,直腸癌患者32例,術(shù)后病理性質(zhì)均為腺癌,分化程度以中分化40例最多,并有低分化6例、中低分化4例、高分化11例、中高分化6例。為方便觀察放化療對(duì)患者排便癥狀的影響,依據(jù)患者入組時(shí)所處的西醫(yī)治療階段將67例患者分為放化療后32例、放化療中17例,和未行放化療18例三組。依據(jù)患者Bristol排便性狀評(píng)分將患者分為便秘型17例,腹瀉型48例,交替型2例。2.臨床特征：對(duì)67例患者的排便相關(guān)癥狀進(jìn)行分析,大腸患者術(shù)后不僅會(huì)出現(xiàn)腹瀉、便秘,其發(fā)生排便急迫感、排便后不盡感等自感癥狀的頻率高于便質(zhì)異常；直腸癌患者發(fā)生排便急迫感、便意感、肛門下墜感三個(gè)癥狀的頻率較高,而結(jié)腸癌患者亦會(huì)出現(xiàn)腹瀉、便秘、排便費(fèi)力、排便后不盡感、肛門直腸疼痛等排便功能損害的癥狀。便秘型的患者多伴有排便費(fèi)力,而排便急迫感、便意感、排便后不盡感、肛門下墜感、肛門直腸疼痛這5項(xiàng)癥狀于腹瀉型、便秘型患者之間發(fā)生率未見明顯差異。正處在放化療中的患者較多出現(xiàn)便秘和肛門直腸疼痛的癥狀,而較少出現(xiàn)腹瀉。對(duì)67例患者中醫(yī)證型進(jìn)行統(tǒng)計(jì),以氣虛證、陽(yáng)虛證、痰濕證、氣滯證、熱毒證出現(xiàn)頻率較高。3.療效評(píng)價(jià)：在辨證中藥治療3個(gè)月后,67例患者大便性狀有顯著改善,排便次數(shù)趨近于正常的1次/日,排便相關(guān)癥狀有顯著改善,患者對(duì)排便過(guò)程的滿意度有顯著提高。67例患者LARSS量表評(píng)分由輕度ARS轉(zhuǎn)變?yōu)闊o(wú)ARS的患者有10例,由重度轉(zhuǎn)變?yōu)檩p度的有16例,由重度轉(zhuǎn)變?yōu)闊o(wú)的有21例,降級(jí)明顯,提示其LARSS相關(guān)癥狀明顯減輕。67例患者辨證中藥治療3個(gè)月后癌癥總生活質(zhì)量量表QLQ-C30相應(yīng)軀體、角色、情緒、認(rèn)知、社會(huì)功能評(píng)分顯著提高,疲乏癥狀評(píng)分較前顯著降低,疼痛、惡心、嘔吐、呼吸困難、失眠、食欲喪失、便秘、腹瀉、經(jīng)濟(jì)困難等癥狀減少,總體健康狀況改善明顯。治療后腸癌患者生活質(zhì)量量表QLQ-CR38相應(yīng)排尿功能、排便功能、認(rèn)知功能評(píng)分明顯提高,胃腸癌相關(guān)癥狀及放化療副反應(yīng)等癥狀評(píng)分顯著降低。結(jié)論：1.大腸癌行保肛根治術(shù)后的患者常出現(xiàn)排便急迫感、排便后不盡感、腹瀉、便意感、排便費(fèi)力、肛門下墜感、便秘、肛門直腸疼痛等不適癥狀,嚴(yán)重影響患者的術(shù)后康復(fù)、生活質(zhì)量及后續(xù)治療。其中,直腸癌患者以排便急迫感、便意感、肛門下墜感尤為多見。2.大腸癌行保肛根治術(shù)后出現(xiàn)排便功能異常的患者常見氣虛證、陽(yáng)虛證、痰濕證、氣滯證、熱毒證,中醫(yī)藥治療以余毒未清、正氣虛損、氣機(jī)失調(diào)為核心病機(jī),以扶正解毒、調(diào)暢氣機(jī)為基本治法,辨病、辨證、辨癥相結(jié)合綜合論治。3.中醫(yī)藥辨治能顯著改善大腸癌術(shù)后患者出現(xiàn)的一系列排便異常癥狀,提高患者的生活質(zhì)量。
[Abstract]:Research objectives: colorectal cancer is one of the most common malignant tumors, mainly including colon and rectal cancer. The incidence of colorectal cancer is increasing year by year in China. Surgical treatment is still the only effective means of radical cure. In recent years, the application of radical anal preserving surgery is increasing gradually, which helps to prolong the life of the patients and improve the quality of life of the patients. The clinical symptoms of constipation, defecation, defecation, defecation, defecation, defecation, diarrhea and incontinence seriously affect the social life and mental state of the patient, and bring great distress to the daily life of the patients. Confidence has reduced the coordination and adaptability of follow-up treatment. Modern medicine pays less attention to this kind of situation, and studies and treats more with "anterior resection syndrome", but the intervention means and curative effect are limited. Traditional Chinese medicine has played an irreplaceable role. From the observation of the curative effect and clinical characteristics of the intervention of the patients with bowel cancer after the operation of traditional Chinese medicine, the clinical features of the patients with abnormal function of defecation after the operation of colon cancer were observed. A comprehensive and systematic observation on symptoms, defecation function and quality of life is carried out in three aspects. It provides a theoretical basis and clinical guidance for Chinese medicine to improve the defecation function of patients after operation of colon cancer. The LARSS, QLQ-C30, QLQ-CR38 quality of life scale and other clinical data were collected, and the statistical analysis of frequency distribution, chi square test, nonparametric rank and test was carried out by SPSS21.0 statistical software. 1. general data: the total of 67 cases of colorectal cancer after radical resection were included, the proportion of men and women was 41:26, the average age was 54.97 + 12. .42 years old (65 years of age) 14 cases, 53 cases under 65 years of age, of which 35 cases of colon cancer, 32 cases of rectal cancer, postoperative pathological properties are adenocarcinoma, differentiation degree to 40 cases of differentiation, 6 cases of low differentiation, moderate and low differentiation of 4 cases, 11 cases of high differentiation, and 6 cases of middle and high differentiation, to observe the effect of radiotherapy and chemotherapy on patient defecation symptoms, depending on the convenience of observation and chemotherapy. According to the Western medical treatment stage, 67 patients were divided into 32 cases after radiotherapy and chemotherapy, 17 in radiotherapy and chemotherapy and 18 in three groups without chemotherapy. According to the patient's Bristol defecation score, the patients were divided into 17 cases of constipation, 48 cases of diarrhoea and 2 cases of alternate type: analysis of bowel related symptoms in 67 patients, large intestine After the operation, the patient not only has diarrhea, constipation, its occurrence of defecation, and the frequency of self feeling symptoms after defecation is higher than that of stool; the frequency of three symptoms of rectal cancer patients has a sense of urgency, meaning, anus falling feeling, and the patients with colon cancer also have diarrhea, constipation, defecation, anus after defecation. The symptoms of defecation dysfunction such as pain in the rectum and other symptoms. The constipation patients are often accompanied by defecation and defecation, and there are 5 symptoms in the patients with diarrhea and constipation. The incidence of constipation and anus in patients undergoing chemotherapy is more than that of constipation and anus. The symptoms of the pain of the portal rectum were less than the diarrhea. 67 cases of TCM syndrome types were counted, with Qi deficiency syndrome, Yang deficiency syndrome, phlegm damp syndrome, qi stagnation syndrome and high frequency of heat toxic syndrome in.3.. After 3 months of TCM treatment, 67 patients had significant improvement in stool characters, the number of defecation was nearly 1 times / day, defecation related symptoms The patient's satisfaction with the process of defecation was significantly improved. The LARSS scale of.67 patients changed from mild ARS to no ARS in 10 cases, from severe to mild 16 cases, from severe change to no one in 21 cases, the lower grade was obvious, suggesting that the LARSS related symptoms of.67 patients were obviously alleviated by TCM treatment for 3 months. The post cancer total quality of life scale (QLQ-C30) related body, role, emotion, cognition, social function score improved significantly, the score of fatigue symptoms decreased significantly, pain, nausea, vomiting, dyspnea, insomnia, loss of appetite, constipation, diarrhea, economic difficulties and other symptoms, and the quality of health improved obviously. The quality of life of the patients with colon cancer after treatment. The corresponding urinary function, defecation function, cognitive function score improved significantly, and the score of the symptoms of gastric cancer and chemotherapy and chemotherapy side effects decreased significantly. Conclusion: 1. large bowel cancer patients after radical resection of the 1. colon cancer patients often have a sense of urgency, after defecation, diarrhea, stool, defecation, anus feeling, constipation, anus. The symptoms of malaise, such as the pain of the rectum, seriously affect the postoperative rehabilitation, the quality of life and the follow-up treatment. Among them, the patients with rectal cancer are particularly sensitive to bowel movement, sense of defecation, sense of meaning, and anus falling feeling especially in.2. colorectal cancer patients with abnormal bowel movement after radical operation, Yang deficiency syndrome, phlegm dampness syndrome, qi stagnation syndrome, heat toxin syndrome, traditional Chinese Medicine In the treatment of medicine, the treatment of.3. can significantly improve a series of abnormal symptoms of defecation and improve the quality of life of the patients after the operation of large intestine cancer.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.34
本文編號(hào)：2161582
[Abstract]:Research objectives: colorectal cancer is one of the most common malignant tumors, mainly including colon and rectal cancer. The incidence of colorectal cancer is increasing year by year in China. Surgical treatment is still the only effective means of radical cure. In recent years, the application of radical anal preserving surgery is increasing gradually, which helps to prolong the life of the patients and improve the quality of life of the patients. The clinical symptoms of constipation, defecation, defecation, defecation, defecation, defecation, diarrhea and incontinence seriously affect the social life and mental state of the patient, and bring great distress to the daily life of the patients. Confidence has reduced the coordination and adaptability of follow-up treatment. Modern medicine pays less attention to this kind of situation, and studies and treats more with "anterior resection syndrome", but the intervention means and curative effect are limited. Traditional Chinese medicine has played an irreplaceable role. From the observation of the curative effect and clinical characteristics of the intervention of the patients with bowel cancer after the operation of traditional Chinese medicine, the clinical features of the patients with abnormal function of defecation after the operation of colon cancer were observed. A comprehensive and systematic observation on symptoms, defecation function and quality of life is carried out in three aspects. It provides a theoretical basis and clinical guidance for Chinese medicine to improve the defecation function of patients after operation of colon cancer. The LARSS, QLQ-C30, QLQ-CR38 quality of life scale and other clinical data were collected, and the statistical analysis of frequency distribution, chi square test, nonparametric rank and test was carried out by SPSS21.0 statistical software. 1. general data: the total of 67 cases of colorectal cancer after radical resection were included, the proportion of men and women was 41:26, the average age was 54.97 + 12. .42 years old (65 years of age) 14 cases, 53 cases under 65 years of age, of which 35 cases of colon cancer, 32 cases of rectal cancer, postoperative pathological properties are adenocarcinoma, differentiation degree to 40 cases of differentiation, 6 cases of low differentiation, moderate and low differentiation of 4 cases, 11 cases of high differentiation, and 6 cases of middle and high differentiation, to observe the effect of radiotherapy and chemotherapy on patient defecation symptoms, depending on the convenience of observation and chemotherapy. According to the Western medical treatment stage, 67 patients were divided into 32 cases after radiotherapy and chemotherapy, 17 in radiotherapy and chemotherapy and 18 in three groups without chemotherapy. According to the patient's Bristol defecation score, the patients were divided into 17 cases of constipation, 48 cases of diarrhoea and 2 cases of alternate type: analysis of bowel related symptoms in 67 patients, large intestine After the operation, the patient not only has diarrhea, constipation, its occurrence of defecation, and the frequency of self feeling symptoms after defecation is higher than that of stool; the frequency of three symptoms of rectal cancer patients has a sense of urgency, meaning, anus falling feeling, and the patients with colon cancer also have diarrhea, constipation, defecation, anus after defecation. The symptoms of defecation dysfunction such as pain in the rectum and other symptoms. The constipation patients are often accompanied by defecation and defecation, and there are 5 symptoms in the patients with diarrhea and constipation. The incidence of constipation and anus in patients undergoing chemotherapy is more than that of constipation and anus. The symptoms of the pain of the portal rectum were less than the diarrhea. 67 cases of TCM syndrome types were counted, with Qi deficiency syndrome, Yang deficiency syndrome, phlegm damp syndrome, qi stagnation syndrome and high frequency of heat toxic syndrome in.3.. After 3 months of TCM treatment, 67 patients had significant improvement in stool characters, the number of defecation was nearly 1 times / day, defecation related symptoms The patient's satisfaction with the process of defecation was significantly improved. The LARSS scale of.67 patients changed from mild ARS to no ARS in 10 cases, from severe to mild 16 cases, from severe change to no one in 21 cases, the lower grade was obvious, suggesting that the LARSS related symptoms of.67 patients were obviously alleviated by TCM treatment for 3 months. The post cancer total quality of life scale (QLQ-C30) related body, role, emotion, cognition, social function score improved significantly, the score of fatigue symptoms decreased significantly, pain, nausea, vomiting, dyspnea, insomnia, loss of appetite, constipation, diarrhea, economic difficulties and other symptoms, and the quality of health improved obviously. The quality of life of the patients with colon cancer after treatment. The corresponding urinary function, defecation function, cognitive function score improved significantly, and the score of the symptoms of gastric cancer and chemotherapy and chemotherapy side effects decreased significantly. Conclusion: 1. large bowel cancer patients after radical resection of the 1. colon cancer patients often have a sense of urgency, after defecation, diarrhea, stool, defecation, anus feeling, constipation, anus. The symptoms of malaise, such as the pain of the rectum, seriously affect the postoperative rehabilitation, the quality of life and the follow-up treatment. Among them, the patients with rectal cancer are particularly sensitive to bowel movement, sense of defecation, sense of meaning, and anus falling feeling especially in.2. colorectal cancer patients with abnormal bowel movement after radical operation, Yang deficiency syndrome, phlegm dampness syndrome, qi stagnation syndrome, heat toxin syndrome, traditional Chinese Medicine In the treatment of medicine, the treatment of.3. can significantly improve a series of abnormal symptoms of defecation and improve the quality of life of the patients after the operation of large intestine cancer.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.34
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