本文關(guān)鍵詞： 脾虛血瘀 原發(fā)性肝癌 健脾化瘀法 中醫(yī)藥　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：肝癌是我國(guó)甚至世界上常見的惡性腫瘤,其預(yù)后具有腫瘤中“最差”之稱,目前一部分肝癌發(fā)現(xiàn)時(shí)已是中晚期,失去了一期手術(shù)切除機(jī)會(huì),對(duì)于不可切除的肝癌患者最常采用經(jīng)皮肝動(dòng)脈栓塞化療術(shù)(TACE)進(jìn)行局部治療,但只是阻止腫瘤局部血供及化療藥局部殺死腫瘤細(xì)胞,介入術(shù)后對(duì)生存質(zhì)量及出現(xiàn)的栓塞術(shù)后系列癥狀的情況影響患者的生活質(zhì)量,中醫(yī)藥在輔助治療肝癌方面存在一定的優(yōu)勢(shì),根據(jù)《金匱要略》肝病治脾之理,通過健脾化瘀法中藥對(duì)肝癌行TACE術(shù)后患者的臨床觀察,進(jìn)一步探索健脾化瘀法中藥在治療TACE術(shù)后肝癌患者的療效及對(duì)其生活質(zhì)量的影響。方法：將符合本研究入組標(biāo)準(zhǔn)80個(gè)病例做為研究對(duì)象,通過采用隨機(jī)對(duì)照研究的方法分為2組,每組各40例,患者均經(jīng)行TACE術(shù)后,治療組采用健脾化瘀法中藥聯(lián)合西醫(yī)對(duì)癥綜合治療,對(duì)照組只采用西醫(yī)對(duì)癥綜合治療,觀察兩組患者治療前及治療后1個(gè)月、3個(gè)月的QOL評(píng)分(包括食欲、精神、睡眠、疲乏、疼痛),生存狀況KPS評(píng)分表及血分析、肝功能,腎功能,凝血功能,AFP及CA19-9,影像學(xué)檢查腫瘤大小變化情況。結(jié)果：1.兩組治療前的一般情況一致性良好,差異無明顯的統(tǒng)計(jì)學(xué)意義(P0.05)。2.兩組患者的療效(RR)進(jìn)行評(píng)估,治療組與對(duì)照組RR的差異無統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者1個(gè)月有效率分別為(治療組：10%,對(duì)照組：10%),3個(gè)月有效率為(治療組：15%,對(duì)照組：5%),雖其療效差異無統(tǒng)計(jì)學(xué)意義,但是術(shù)后1個(gè)月健脾化瘀組惡化(PD)病例數(shù)較對(duì)照組少(34),術(shù)后3個(gè)月健脾化瘀組惡化(PD)病例數(shù)較對(duì)照組少(1012),術(shù)后3個(gè)月健脾化瘀組部分緩解(PR)病例數(shù)較對(duì)照組多(62)。兩組的臨床緩解率雖其療效差異無統(tǒng)計(jì)學(xué)意義,TACE術(shù)后1個(gè)月兩組患者的臨床獲益率分別為(治療組：92.5%,對(duì)照組：90%),兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后3個(gè)月兩組患者的臨床獲益率分別為(治療組：75%,對(duì)照組：70%),治療組的獲益率大于對(duì)照組。3.肝臟功能：兩組患者TACE術(shù)后健脾化瘀中藥治療1個(gè)月后的AST、ALT、TB、ALB差異有統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者TACE術(shù)后健脾化瘀中藥治療3個(gè)月后的AST、ALT、TB、ALB差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.腫瘤指標(biāo)：兩組患者術(shù)后1個(gè)月、3個(gè)月CA19-9差異無統(tǒng)計(jì)學(xué)意義(P0.05)；兩組患者TACE術(shù)后1個(gè)月AFP差異有統(tǒng)計(jì)學(xué)意義(P=0.0320.05),兩組患者TACE術(shù)后3個(gè)月AFP差異有統(tǒng)計(jì)學(xué)意義(P=0.0340.05),兩組患者治療1個(gè)月后及3個(gè)月后的AFP下降值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。5.QOL生活質(zhì)量：食欲、精神、睡眠、乏力、疼痛這五個(gè)癥狀,肝癌TACE術(shù)后1個(gè)月兩組患者癥狀評(píng)分經(jīng)秩和檢驗(yàn)后除食欲外,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后3個(gè)月兩組患者食欲、睡眠兩個(gè)癥狀差異具有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后3個(gè)月兩組患者精神、乏力、疼痛三個(gè)癥狀差異無統(tǒng)計(jì)學(xué)意義(P0.05)。五個(gè)癥狀的總體評(píng)分,兩組患者TACE術(shù)后1個(gè)月總積分比較(Z=3.136,P=0.002)差異有統(tǒng)計(jì)學(xué)意義(P0.05),3個(gè)月的總積分比較(Z=3.098,P=0.02)差異有統(tǒng)計(jì)學(xué)意義(P0.05) ；6.兩組患者生存質(zhì)量KPS評(píng)分：TACE術(shù)后1個(gè)月兩組患者的KPS評(píng)分比較(Z=2.230,P=0.026)差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后3個(gè)月比較(Z=1.990,P=0.047)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：健脾化瘀法組方的中藥在改善肝癌患者TACE術(shù)后脾虛血瘀證患者有積極作用,在一定程度上可以改善患者肝功能,改善患者睡眠及飲食情況,提高患者的生活質(zhì)量。
[Abstract]:Objective: liver cancer is our country and even the world common malignant tumor, its prognosis with tumor in the "worst", currently part of hepatocellular carcinoma is advanced when found, lost an opportunity to surgery, for unresectable liver cancer most commonly used percutaneous hepatic artery embolization chemotherapy (TACE) local treatment, but only to prevent the local blood supply of tumors and local chemotherapy drugs kill tumor cells, the influence of the quality of life and the emergence of the series of symptoms after embolization of the quality of life of patients after interventional therapy, traditional Chinese medicine has some advantages in the adjuvant treatment of liver cancer, according to < > liver spleen Jinkui yaolue Daniel the traditional Chinese medicine of invigorating spleen and removing blood stasis, clinical observation of patients after TACE for hepatocellular carcinoma, to further explore the Chinese medicine invigorating spleen and removing blood stasis in the treatment of TACE postoperative liver cancer patients and the influence on the quality of life. Methods: according to This study enrolled 80 cases as the research object, by using the random control study divided into 2 groups, 40 cases in each group, patients were treated after TACE, treatment group were treated with Jianpi Huayu of Chinese medicine combined with western medicine symptomatic treatment, while the control group only with western medicine treatment, observation of 1 months two groups of patients before and after treatment, 3 months QOL score (including spirit, appetite, sleep, fatigue, pain), survival analysis, KPS score and serum liver function, renal function, blood coagulation function, AFP and CA19-9 imaging of tumor size changes. Results: the general situation of the 1. two before treatment, good consistency, no difference was statistically significant (P0.05.2.) the curative effect of two groups of patients (RR) were evaluated, no statistically significant difference between treatment group and control group RR (P0.05), two groups of patients 1 months respectively (the treatment group: 10%, control group: 10% ),3涓湀鏈夋晥鐜囦負(fù)(娌葷枟緇勶細(xì)15%,瀵圭収緇勶細(xì)5%),铏藉叾鐤楁晥宸紓鏃犵粺璁″鎰忎箟,浣嗘槸鏈悗1涓湀鍋ヨ劸鍖栫榾緇勬伓鍖，

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