【摘要】：1.研究背景和目的:外科手術(shù)是食管癌的首要治療方式,但是因?yàn)榻馄饰恢锰厥?且發(fā)病對(duì)象多見于中老年患者,術(shù)后并發(fā)癥發(fā)生率高。術(shù)后并發(fā)癥的發(fā)生給食管癌術(shù)后患者帶來(lái)一系列不適癥狀,嚴(yán)重影響了患者生活質(zhì)量的提高。目前西醫(yī)在食管癌術(shù)后并發(fā)癥方面沒有有效的治療方案,僅僅以對(duì)癥支持治療或者改善手術(shù)治療方式為主。中醫(yī)藥參與的綜合治療是我國(guó)食管癌治療的重要特色,既往的臨床實(shí)踐顯示:中醫(yī)藥在食管癌術(shù)后階段具有一定減輕術(shù)后并發(fā)癥,促進(jìn)快速康復(fù),防止轉(zhuǎn)移復(fù)發(fā)作用。本研究以食管癌術(shù)后患者為研究對(duì)象,從中醫(yī)藥治療食管癌術(shù)后相關(guān)癥狀入手,術(shù)后以中氣下陷為核心病機(jī),以益氣升陷為主要治療大法,病證癥結(jié)合法論治食管癌術(shù)后患者,通過(guò)現(xiàn)代統(tǒng)計(jì)學(xué)方法,研究食管癌術(shù)后癥狀的臨床特征和影響食管癌術(shù)后癥狀的相關(guān)因素,探討食管癌術(shù)后常見的中醫(yī)證型,評(píng)價(jià)辨證中藥干預(yù)治療食管癌術(shù)后癥狀的臨床療效,為臨床實(shí)踐提供證據(jù)。2.研究?jī)?nèi)容與方法:本研究共納入76例食管癌單純術(shù)后治療患者,結(jié)合食管癌術(shù)后不適癥狀評(píng)估表、QLQ—OES18食管癌特異模塊量表及QLQ—C30腫瘤生活質(zhì)量量表,通過(guò)面對(duì)面和電話隨訪完成調(diào)查,運(yùn)用分層聚類分析法、頻數(shù)分析法、斯皮爾曼法(spearman)對(duì)術(shù)后患者不適癥狀進(jìn)行評(píng)估分析;同時(shí)對(duì)初治的食管癌術(shù)后患者30例,采取開放性臨床試驗(yàn)方法,通過(guò)自身前后對(duì)照,觀察辨證中藥干預(yù)治療后癥狀改善的臨床療效。3.研究結(jié)果:3.1 一般資料:共納入76例食管癌術(shù)后患者,男性58例,占76.32%,女性18例,占23.68%,男女之比為3.22:1;患者年齡在46-81歲之間,其中55歲者20例,占 26.31%,55-65 歲者 43 例,占 56.58%,65 歲者 13 例,占 17.11%;疾病分期中Ⅰ期29例,占38.16%,Ⅱ期23例,占30.26%,Ⅲ期24例,占31.58%;病變部位中上段9例,占11.84%,中段40例,占52.63%,下段27例,占35.53%;病理類型中鱗癌51例,占67.11%,腺癌25例,占32.89%;病理分化程度中低分化19例,占25%,中分化44例,占57.89%,高分化13例,占17.11%;術(shù)后3個(gè)月48例,占63.16%,術(shù)后3-6個(gè)月18例,占23.68%,6個(gè)月10例,占13.16%;術(shù)式中經(jīng)左胸后外切口食管次全切、胃食管弓上吻合術(shù)31例,占40.79%,食管次全切、結(jié)腸/空腸代食管術(shù)14例,占18.42%,內(nèi)鏡下食管局部病變切除術(shù)8例,占10.53%,頸、胸、腹三切口食管次全切、胃食管頸部吻合術(shù)16例,占21.05%,Ivor-Lewis手術(shù)7例,占9.21%;術(shù)前合并其他疾病37例,占48.68%,術(shù)前無(wú)其他疾病39例,占51.32%;具有吸煙史41例,占53.95%,無(wú)吸煙史35例,占46.05%;具有飲酒史49例,占49.47%,無(wú)飲酒史27例,占 35.53%;3.2術(shù)后不適癥狀由高到低排名前十位依次為氣短、疲乏、食欲減退、異物感、口干、呃逆、反酸、吞咽疼痛、腹瀉、吞咽困難;聚類分析顯示:術(shù)后主要集中在2大類癥狀,一類是氣短、疲乏、食欲減退;另一類是:呃逆、反酸、胃脹、吞咽困難、腹瀉、口干、吐黏痰、聲音嘶啞等;術(shù)后3個(gè)月的癥狀為24.28±7.15,術(shù)后3-6個(gè)月的為22.40±9.39,術(shù)后6個(gè)月為22.27±6.92;3.3食管癌術(shù)后男性患者不適癥狀平均積分(25.93±9.40)高于女性患者(22.29±5.63),但是二者之間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后不同分期的患者,術(shù)后不適癥狀平均積分由高到低依次為Ⅲ期、Ⅱ期、Ⅰ期,隨著分期越晚,不適癥狀平均積分越高,但是不同分期之間無(wú)統(tǒng)計(jì)學(xué)差異(p0.05);食管癌術(shù)后不同年齡階段的患者,隨著年齡增長(zhǎng),術(shù)后不適癥狀平均積分增加,經(jīng)非參數(shù)卡方檢驗(yàn)顯示各年齡階段之間有顯著統(tǒng)計(jì)學(xué)差異(p0.01);不同的手術(shù)方式亦是對(duì)食管癌術(shù)后的影響因素之一,內(nèi)鏡下食管局部病變切除術(shù)后不適癥狀平均積分最少(11.00±4.30),頸、胸、腹三切口食管次全切、胃食管頸部吻合術(shù)后不適癥狀平均積分最高(28.67±9.18),經(jīng)非參數(shù)卡方檢驗(yàn)顯示不同手術(shù)方式之間存在統(tǒng)計(jì)學(xué)差異(p0.05);此外不同病理類型、分化程度及病變部位對(duì)術(shù)后不適癥狀影響不大,經(jīng)過(guò)非參數(shù)卡方檢驗(yàn)顯示無(wú)統(tǒng)計(jì)學(xué)差異(p0.05);3.4疲乏、食欲喪失、吞咽困難、腹瀉、反酸、氣短與生活質(zhì)量具有相關(guān)性,疲乏可以嚴(yán)重影響軀體功能(Rho=0.749,P0.01);3.5食管癌術(shù)后證型分布依次為氣虛證(50%)、痰濕證(46.5%)、氣滯證(30.26%)、陽(yáng)虛證(19.74%)、陰虛證(17.11%)、血瘀證(9.21%)、熱毒證(5.26%);3.6基于病、證、癥三位一體的治療理念,芪術(shù)郁靈湯辨證加減治療后,社會(huì)功能、認(rèn)知功能、情緒功能、角色功能、軀體功能較治療前差異顯著(P0.01);能夠減輕疲倦、氣促、失眠、食欲喪失、腹瀉、吞咽困難、口干等癥狀(P0.05),尤其是對(duì)疲倦、氣促、食欲喪失、腹瀉的癥狀改善較為顯著(P0.01),患者的總體健康狀況也顯著提高(P0.01)。4.研究結(jié)論:4.1食管癌術(shù)后主要存在氣短、疲乏、食欲減退等核心癥狀;術(shù)后不適癥狀隨時(shí)間延長(zhǎng)而降低,但是在術(shù)后3-6月以后下降不顯著;4.2年齡、手術(shù)方式是影響術(shù)后不適癥狀的重要因素;4.3食管癌術(shù)后的證型分布為虛實(shí)夾雜,以氣虛痰濕為主;4.4芪術(shù)郁靈湯辨證加減治療后能夠提高患者的生活質(zhì)量,可以提高軀體、角色、情緒、認(rèn)知、社會(huì)功能及總健康狀況,并能夠有效改善疲倦、氣促、失眠、食欲喪失、吞咽困難、口干等癥狀。
[Abstract]:1. research background and objective: surgical operation is the primary treatment of esophageal cancer, but because of the special anatomical location, the incidence of postoperative complications is high. The postoperative complications bring a series of discomfort symptoms to the patients after esophagus cancer surgery, which seriously affects the improvement of the quality of life of the patients. Currently, the patient's quality of life is greatly improved. There is no effective treatment for the postoperative complications of esophagus cancer, only with symptomatic support or improvement of surgical treatment. The comprehensive treatment of traditional Chinese medicine is an important feature of the treatment of esophageal cancer in our country. The previous clinical practice shows that traditional Chinese medicine can reduce postoperative complications and promote the postoperative complications of esophageal cancer. This study took the patients after esophagus cancer as the research object, starting with the treatment of the related symptoms of esophagus cancer after the operation of esophagus cancer, with the central qi depression as the core pathogenesis after the operation, the main treatment of the Qi subsidence as the major treatment, the syndrome of the disease after the operation of the esophagus cancer patients, and the study of the esophagus through the modern statistical method. The clinical features of postoperative symptoms of cancer and the related factors affecting the postoperative symptoms of esophageal cancer, explore the common TCM syndrome types after esophagus cancer surgery, evaluate the clinical efficacy of TCM syndrome differentiation in the treatment of postoperative symptoms of esophageal cancer, provide evidence and methods of evidence.2. for clinical practice: This study included 76 patients with esophageal cancer after simple surgical treatment. The postoperative discomfort assessment table, the QLQ - OES18 esophageal cancer specific module scale and the QLQ - C30 tumor quality of life scale were investigated by face-to-face and telephone follow-up. The stratified cluster analysis, frequency analysis, and Spielman method (Spearman) were used to evaluate the discomfort symptoms of the patients after the operation; at the same time, the primary esophagus was treated. 30 cases of postoperative patients were treated with open clinical trial. Through their own pre and post control, the clinical results of symptoms improvement of TCM syndrome differentiation after treatment were observed: 3.1 general data: 76 cases of esophageal cancer were included in 76 cases, 58 men, 76.32%, 18 women, 23.68%, and 3.22:1; the age of the patients was 46-81 years old. Among them, there were 20 cases of 55 years old, 43 cases of 55-65 years old, 56.58% and 17.11% in 65 years, 29 cases in stage I, 38.16% in stage I, 23 cases in stage II, accounting for 30.26% and third stage; There were 25 cases of cancer, accounting for 32.89%, 19 cases of low differentiation in pathological differentiation, 44 cases of middle differentiation, 57.89% of middle differentiation, 13 cases of high differentiation, 17.11%, 48 cases, 63.16%, 18 cases in 3 months after operation, 18 cases in 3-6 months, accounting for months, and esophagogastric anastomosis of gastroesophageal arch, esophagogastric resection, and esophagogastric anastomosis. Colon / jejunostomy was performed in 14 cases, accounting for 18.42%. Endoscopic esophagectomy was performed in 8 cases, accounting for 10.53%, cervical, thoracic and abdominal three incision subtotal esophagectomy, 16 cases of gastroesophageal neck anastomosis, 21.05% of gastroesophageal neck anastomosis, 7 cases with Ivor-Lewis operation, 9.21%, 37 cases with other diseases before operation, 48.68%, 39 cases without other diseases before operation, accounted for 51.32%; smoking history accounted for 51.32%; smoking history accounted for 41 cases. 53.95%, no smoking history of 35 cases, accounting for 46.05%, 49 cases of drinking history, 49.47%, and no history of alcohol consumption, 27 cases, accounting for 35.53%. 3.2 postoperative discomfort symptoms from high to low ranking in the first ten place were short, fatigue, appetite reduction, foreign body sensation, dry mouth, hiccup, deglutition, swallowing pain, abdominal diarrhea, dysphagia. Cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed 2 major symptoms after operation, cluster analysis showed after operation, 2 major symptoms, mainly concentrated after operation, after operation, cluster analysis showed mainly in 2 classes, diarrhea after operation, cluster analysis showed mainly concentrated in 2 major symptoms after the operation, One type is shortness of breath, fatigue and anorexia, and the other is hiccup, acid, stomach distention, dysphagia, diarrhea, dry mouth, spitting, phlegm, hoarseness, and so on; the symptoms of 3 months after operation are 24.28 + 7.15, 3-6 months after operation are 22.40 + 9.39, 6 months after operation 22.27 + 6.92; the average integral of discomfort symptoms (25.93 + 9.40) after 3.3 esophagus carcinoma (3.3) is higher than that of women. There was no statistical difference (22.29 + 5.63), but there was no statistical difference between the two (P0.05). The average integral of discomfort symptoms after the operation in different stages from high to low was in stage III, II, stage I, the higher the average integral of discomfort symptoms, but there was no statistical difference between different stages (P0.05). The average integral of discomfort symptoms increased with age, and the non parametric chi square test showed significant statistical difference between all ages (P0.01), and the different surgical methods were also one of the factors affecting the postoperative esophagectomy. The average score of discomfort symptoms after endoscopic esophagectomy was least (11 + 4.3). 0) the average integral of the three incision of the neck, the chest and the abdomen was the highest (28.67 + 9.18) after the gastroesophageal neck anastomosis. The non parametric chi square test showed that there was a statistical difference between the different surgical methods (P0.05). In addition, the different pathological types, the degree of differentiation and the lesion site had little influence on the postoperative discomfort symptoms, and the non parameter card was passed. The square test showed no statistical difference (P0.05); 3.4 fatigue, loss of appetite, dysphagia, diarrhea, anacid, shortness of breath were associated with the quality of life, fatigue could seriously affect the body function (Rho=0.749, P0.01); 3.5 after esophagus cancer, the distribution of syndrome type was Qi deficiency syndrome (50%), phlegm damp syndrome (46.5%), qi stagnation syndrome (30.26%), Yang deficiency syndrome (19.74%), yin deficiency syndrome (syndrome of deficiency syndrome) (19.74%). 17.11%), blood stasis syndrome (9.21%), heat toxic syndrome (5.26%); 3.6 based on the treatment concept of disease, syndrome, syndrome, syndrome, syndrome, syndrome differentiation and reduction treatment, the social function, cognitive function, emotional function, role function and body function are significantly different than before treatment (P0.01), and can reduce fatigue, shortness of breath, insomnia, loss of appetite, diarrhea, dysphagia, dry mouth and so on Symptoms (P0.05), especially for fatigue, shortness of breath, loss of appetite, and symptoms of diarrhea were significantly improved (P0.01), and the overall health of the patients was also significantly improved (P0.01).4. research conclusion: 4.1 after esophagus cancer, the main symptoms such as shortness of breath, fatigue, anorexia, and so on; the postoperative symptoms of discomfort decreased with time, but 3-6 months after the operation, The postoperative decline was not significant; 4.2 age, the operation mode was an important factor affecting the postoperative discomfort symptoms; 4.3 after the operation of esophageal cancer, the distribution of syndrome type was false and solid, and Qi deficiency phlegm dampness was the main factor. 4.4 Qi Yu Ling soup can improve the quality of life and can improve body, role, emotion, cognition, social function and general health condition. And can effectively improve fatigue, shortness of breath, insomnia, loss of appetite, dysphagia, dry mouth and other symptoms.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳家遠(yuǎn);芮玉峰;耿耿;張磊;;三種手術(shù)徑路治療食管癌并發(fā)癥的比較[J];現(xiàn)代腫瘤醫(yī)學(xué);2017年05期

2 萬(wàn)富芳;;不同手術(shù)入路治療胸中段食管癌的臨床療效比較[J];中國(guó)現(xiàn)代藥物應(yīng)用;2017年02期

3 張柯;;左胸小切口手術(shù)治療老年食管癌患者33例效果觀察[J];河南外科學(xué)雜志;2017年01期

4 朱詩(shī)國(guó);許政旭;羅俊;潘年松;廖彬汛;;黔產(chǎn)莪術(shù)油對(duì)人直腸癌細(xì)胞血管生成因子表達(dá)的影響[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2017年04期

5 吳成亞;馮穎;李杰;;基于循證醫(yī)學(xué)的中醫(yī)藥治療食管癌作用特點(diǎn)研究概述[J];山東中醫(yī)雜志;2016年12期

6 李欽;胡繼宏;高博;李海東;宋爽;楊麗霞;;黃芪多糖在免疫調(diào)節(jié)方面的最新研究進(jìn)展[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2017年02期

7 吳成亞;宋卓;李杰;;芪術(shù)郁靈湯辨治食管癌經(jīng)驗(yàn)[J];中醫(yī)雜志;2016年21期

8 程春;黃向華;許峰;施明新;冷超;張衛(wèi)華;;食管癌術(shù)后胃腸功能障礙治療體會(huì)[J];現(xiàn)代腫瘤醫(yī)學(xué);2016年24期

9 吳成亞;馮穎;李杰;;基于中醫(yī)體質(zhì)學(xué)說(shuō)研究中醫(yī)藥防治胃癌優(yōu)勢(shì)人群的作用和意義[J];世界華人消化雜志;2016年24期

10 郭秋均;李叢煌;花寶金;;解毒活血藥調(diào)控腫瘤新生血管形成機(jī)制的研究進(jìn)展[J];中華中醫(yī)藥雜志;2016年07期

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