本文選題：局部辨證 + 消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂��； 參考：《北京中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：惡性腫瘤長(zhǎng)期處于我國疾病死亡率的前三位,其中消化系統(tǒng)腫瘤是最常見的惡性腫瘤,根據(jù)《2012年中國腫瘤登記年報(bào)》數(shù)據(jù),發(fā)病率和死亡率前五位的惡性腫瘤中,消化系統(tǒng)惡性腫瘤各占據(jù)了其中四位。手術(shù)是治療消化系統(tǒng)惡性腫瘤的重要手段之一,術(shù)后胃腸功能紊亂是消化系統(tǒng)惡性腫瘤術(shù)后常見并發(fā)癥之一,主要包括術(shù)后胃癱、術(shù)后麻痹性腸梗阻、術(shù)后單純惡心嘔吐和術(shù)后腹瀉四個(gè)方面,其發(fā)病率較之普通腹部外科術(shù)后胃腸功能紊亂尤高。消化系統(tǒng)腫瘤患者術(shù)后往往還需要行化療、放療等后續(xù)治療,術(shù)后及時(shí)盡早地恢復(fù)患者的胃腸功能,是進(jìn)行下一步治療的前提,而對(duì)于不進(jìn)行下一步治療的患者,術(shù)后胃腸功能也是影響其預(yù)后的重要因素。 本病的發(fā)病機(jī)制尚不十分明確,目前研究認(rèn)為其發(fā)生與手術(shù)導(dǎo)致的解剖結(jié)構(gòu)改變、炎癥反應(yīng)、神經(jīng)損傷,以及術(shù)中術(shù)后麻醉藥物的運(yùn)用,感染、全身營(yíng)養(yǎng)狀況、基礎(chǔ)疾病、電解質(zhì)紊亂、精神狀況等因素有關(guān)。西醫(yī)治療以營(yíng)養(yǎng)支持、減輕胃腸道負(fù)荷、藥物或局部刺激調(diào)整胃腸道動(dòng)力、調(diào)節(jié)腸道菌群等方法為主,但由于西醫(yī)治療時(shí)并沒有根據(jù)腫瘤患者的特點(diǎn)將其與普通腹部外科術(shù)后患者進(jìn)行區(qū)分治療,許多消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的患者缺乏有效治療。 現(xiàn)代中醫(yī)治療本病取得了較好的臨床療效,并針對(duì)其所包含的各個(gè)疾病進(jìn)行了廣泛的研究,對(duì)其中醫(yī)范疇、病因病機(jī)及中醫(yī)治療均形成了一定的認(rèn)識(shí),研究報(bào)道主要是對(duì)各個(gè)疾病分別進(jìn)行經(jīng)驗(yàn)總結(jié)、臨床觀察及實(shí)驗(yàn)研究等,尚未有人將各個(gè)疾病綜合起來系統(tǒng)地進(jìn)行分析總結(jié),缺乏對(duì)疾病總結(jié)性的認(rèn)識(shí)和規(guī)范性的治療。 導(dǎo)師左明煥教授長(zhǎng)期致力于消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的治療和研究,認(rèn)識(shí)到中醫(yī)對(duì)消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂理論認(rèn)識(shí)的不完善限制了臨床療效,通過對(duì)中醫(yī)古籍和現(xiàn)代文獻(xiàn)的研究,對(duì)其進(jìn)行整理、分析、總結(jié),并結(jié)合導(dǎo)師自身豐富的臨床經(jīng)驗(yàn),對(duì)本病因病機(jī)、辨證要點(diǎn)以及臨床治療進(jìn)行了系統(tǒng)的闡釋。 論文主要包括文獻(xiàn)綜述,文獻(xiàn)研究和理論闡釋兩部分： 文獻(xiàn)綜述分為兩篇,一篇為消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的西醫(yī)研究進(jìn)展,總結(jié)了消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的西醫(yī)分類,各病的發(fā)病機(jī)制、臨床診斷和治療現(xiàn)狀。另一篇為消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂中醫(yī)研究進(jìn)展,整理了消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的中醫(yī)基本認(rèn)識(shí)、病因病機(jī)、治療方法和各醫(yī)家經(jīng)驗(yàn),總結(jié)了現(xiàn)代中醫(yī)藥對(duì)消化系統(tǒng)惡性腫瘤術(shù)后胃腸功能紊亂的診療現(xiàn)狀。 正文部分通過對(duì)中醫(yī)古代文獻(xiàn)的研究、以及現(xiàn)代治法用藥的統(tǒng)計(jì)分析,對(duì)本病的中醫(yī)歸屬、病因病機(jī)、辨證要點(diǎn)及治法治則進(jìn)行了系統(tǒng)地闡釋,總結(jié)得出本病主要包括,術(shù)后胃癱、術(shù)后麻痹性腸梗阻、術(shù)后單純惡心嘔吐和術(shù)后腹瀉四個(gè)部分,分別歸屬于中醫(yī)“痞滿”、“嘔吐”、“腹脹”“納呆”“胃反”；“腸結(jié)”；“嘔吐”；“腹瀉”等疾病范疇。指出其病因病機(jī)主要為正氣不足、脾胃虛弱,金刀所致、臟腑受損,脈絡(luò)受損、氣滯血瘀和肝失疏泄四個(gè)方面,而脾胃虛弱和臟腑受損為其病機(jī)關(guān)鍵。提出了本病的辨證關(guān)鍵在于區(qū)別腫瘤患者與普通外科患者、局部辨證與全身辨證等方面。并針對(duì)性地指出目前治療術(shù)后胃癱、術(shù)后麻痹性腸梗阻以口服湯藥治療存在刺激吻合口、增加胃腸道負(fù)荷等風(fēng)險(xiǎn)；以及目前醫(yī)家一味采用攻下法治療腫瘤患者,在其正氣不足的基礎(chǔ)上可能進(jìn)一步加重正虛的不足,創(chuàng)新性地提出了在局部辨證的基礎(chǔ)上以中藥外治治療為主的治療理念,解決了全身正虛與局部邪實(shí)的治療矛盾,并彌補(bǔ)了術(shù)后惡心嘔吐中藥治療的空白。
[Abstract]:The digestive system tumor is one of the most common malignant tumors in our country . The digestive system tumor is one of the most common malignant tumors in the digestive system . The operation is one of the most common complications in the digestive system malignant tumor . The postoperative gastrointestinal dysfunction is one of the most common complications in the digestive system malignant tumor .

The pathogenesis of this disease is not very clear . At present , it is considered that it is related to the changes of anatomical structure , inflammatory reaction , nerve injury , basic disease , electrolyte disturbance , mental condition and so on .

Modern Chinese medicine has achieved good clinical curative effect in treating the disease , and has made extensive research on the various diseases it contains , and has formed a certain understanding of the traditional Chinese medicine category , the cause disease machine and the traditional Chinese medicine treatment .

Professor Zuo Ming - hwan , a mentor , has long been devoted to the treatment and study of gastrointestinal dysfunction after digestive system malignant tumor . It is recognized that TCM has limited clinical curative effect on the theory of gastrointestinal dysfunction after digestive system malignant tumor . Through the study of Chinese ancient books and modern literature , it organizes , analyzes and summarizes them , and combines with the abundant clinical experience of the tutor themselves , and systematically explains this disease pathogenesis , syndrome differentiation point and clinical treatment .

The thesis mainly includes literature review , literature research and theoretical interpretation .

Literature review is divided into two articles , one is the western medicine research progress of gastrointestinal dysfunction after digestive system malignant tumor , summarizes the western medicine classification of gastrointestinal dysfunction after digestive system malignant tumor , the pathogenesis , clinical diagnosis and treatment status of each disease .

The main part of this study is the study of ancient Chinese medical literature and the statistical analysis of modern medical treatment . It is concluded that this disease mainly includes four parts of traditional Chinese medicine ' fullness ' , " vomiting " , " abdominal distension " , " anorexia " and " stomach reverse " .
" Enteral junction " ;
" vomiting " ;
It points out that the pathogenesis of the disease is mainly the deficiency of vital qi , weakness of the spleen and stomach , the result of the golden knife , the damage of the zang - fu organs , the damage of the veins and collaterals , the stagnation of qi and blood stasis and the loss of the liver . The key of the differentiation of the disease is to distinguish between the tumor patients and the general surgical patients , the local syndrome differentiation and the whole body syndrome differentiation .
At present , the traditional Chinese medicine is used to treat the tumor patients by the attack method , and the deficiency of positive deficiency may be further aggravated on the basis of the deficiency of the normal qi , and the treatment principle based on the local syndrome differentiation and the external treatment of the traditional Chinese medicine is creatively put forward , so that the treatment contradiction of the whole body positive virtual and the local evil is solved , and the blank of the traditional Chinese medicine treatment for nausea and vomiting after operation is made up .
【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】：2014
【分類號(hào)】：R273

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