本文選題：膽囊息肉樣病變 + 息肉直徑�。� 參考：《安徽中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:探討膽囊息肉樣病變不同直徑大小的體質(zhì)分布及膽囊息肉樣病變病理性質(zhì)與體質(zhì)之間的關(guān)系,為膽囊息肉樣病變的中醫(yī)預(yù)防與治療提供思路。方法:選取武警安徽省總隊(duì)醫(yī)院體檢中心或住院部符合各組納入條件的人群作為研究對(duì)象,其中將體檢中心健康人群作為對(duì)照組;直徑8mm的膽囊息肉樣變患者作為膽囊息肉(非危險(xiǎn))組;直徑≥8mm的膽囊息肉樣變患者作為膽囊息肉(危險(xiǎn))組。分析比較三組之間的體質(zhì)分布特點(diǎn)及差異,研究?jī)山M膽囊息肉中息肉多發(fā)體質(zhì)與臨床檢查結(jié)果間是否具有特異性,探析膽囊息肉(危險(xiǎn))組患者的病理性質(zhì)與體質(zhì)之間的關(guān)系,并初步研究膽囊癌患者的體質(zhì)分布情況及相關(guān)性。結(jié)果:(1)(1)三組CHOL均值進(jìn)行兩兩之間的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);(2)膽囊息肉(危險(xiǎn))組中的LDL-C均值與膽囊息肉(非危險(xiǎn))組和對(duì)照組兩組的差異分別具有統(tǒng)計(jì)學(xué)意義(P0.05),而膽囊息肉(非危險(xiǎn))組與對(duì)照組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)(1)對(duì)照組與膽囊息肉(非危險(xiǎn))組之間,對(duì)照組中平和質(zhì)的分布顯著多(P0.0167);膽囊息肉(非危險(xiǎn))組中氣虛質(zhì)的分布顯著多于對(duì)照組(P0.0167);膽囊息肉(非危險(xiǎn))組中痰濕質(zhì)的分布顯著多于對(duì)照組(P0.0167);兩組間其余體質(zhì)分布情況中,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.0167)。(2)對(duì)照組與膽囊息肉(危險(xiǎn))組之間,對(duì)照組中平和質(zhì)的分布顯著多于膽囊息肉(危險(xiǎn))組(P0.0167);膽囊息肉(危險(xiǎn))組中陽(yáng)虛質(zhì)、痰濕質(zhì)、濕熱質(zhì)的分布顯著多于對(duì)照組(P0.0167);兩組間其余體質(zhì)分布差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.0167)。(3)膽囊息肉(非危險(xiǎn))組與膽囊息肉(危險(xiǎn))組之間,膽囊息肉(危險(xiǎn))組中陽(yáng)虛質(zhì)的分布顯著多于膽囊息肉(非危險(xiǎn))組(P0.0167)。兩組間其余體質(zhì)分布差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.0167)。(3)兩組膽囊息肉樣變間的合并病對(duì)比,膽囊息肉(危險(xiǎn))組中高血脂癥患者明顯多于膽囊息肉(非危險(xiǎn))組(P0.05)。(4)膽囊息肉(非危險(xiǎn))組與膽囊息肉(危險(xiǎn))組之間,在生長(zhǎng)部位(膽囊體和膽囊底)、膽囊壁厚度方面的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)(1)膽囊息肉(非危險(xiǎn))組中,氣虛質(zhì)患者的合并病發(fā)病率分別為:高血脂癥(13.04%)=高血壓病(13.04%)=脂肪肝(13.04%)糖尿病(8.7%)=肝囊腫(8.7%)膽結(jié)石(4.35%);痰濕質(zhì)患者的合并病發(fā)病率分別為:脂肪肝(43.48%)高血壓病(39.13%)高血脂癥(26.09%)糖尿病(17.39%)肝囊腫(13.04%)膽結(jié)石(4.35%);(2)膽囊息肉(危險(xiǎn))組中,痰濕質(zhì)患者的合并病發(fā)病率分別為:高血脂癥(45.45%)高血壓病(31.82%)糖尿病(18.18%)脂肪肝(13.64%)=乙肝(13.64%)肝囊腫(9.09%)膽結(jié)石(4.55%);濕熱質(zhì)患者的合并病發(fā)病率分別為:高血脂癥(40%)脂肪肝(25%)肝囊腫(20%)=膽結(jié)石(20%)高血壓病(10%)=糖尿病(10%)=乙肝(10%);陽(yáng)虛質(zhì)患者的合并病發(fā)病率分別為:高血脂癥(15.79%)肝囊腫(10.53%)高血壓病(5.26%)=膽結(jié)石(5.26%)。(6)膽囊息肉(危險(xiǎn))組中,膽固醇性息肉患者體質(zhì)分布情況為:痰濕質(zhì)(22.09%)陽(yáng)虛質(zhì)(18.6%)濕熱質(zhì)(13.95%)氣虛質(zhì)(11.63%);膽囊腺肌增生體質(zhì)分布情況為:氣虛質(zhì)、痰濕質(zhì)和氣郁質(zhì)各有1例;腺瘤性息肉患者體質(zhì)分布情況為:陽(yáng)虛質(zhì)(36.36%)=濕熱質(zhì)(36.36%)痰濕質(zhì)(18.18%)血淤質(zhì)(9.09%)(7)膽囊癌患者中,性別女性7位,占77.78%;年齡為53~84歲,平均年齡為69.22歲;急性發(fā)作者6例,占66.7%;合并膽結(jié)石者占88.89%(8/9);B超或CT獲取膽囊癌病情3例,占33.3%;腫瘤標(biāo)志物CA199升高者5例,占55.56%;意外膽囊癌5例,占55.56%;病理類型以腺癌(7例)為主,占77.78%;癌變部位多位于體部(6例),占66.7%;體質(zhì)類型分為濕熱質(zhì)、血瘀質(zhì)、陽(yáng)虛質(zhì)。結(jié)論:(1)(1)對(duì)照組中,以平和質(zhì)患者分布為主;(2)膽囊息肉(非危險(xiǎn))組中,以氣虛質(zhì)、痰濕質(zhì)患者分布為主;(3)膽囊息肉(危險(xiǎn))組中,以陽(yáng)虛質(zhì)、痰濕質(zhì)、濕熱質(zhì)患者分布為主,且陽(yáng)虛質(zhì)患者顯著多于膽囊息肉(非危險(xiǎn))組;(4)痰濕質(zhì)多見(jiàn)于膽囊息肉樣病變患者。(2)(1)在膽囊息肉(非危險(xiǎn))組中,脂肪肝、高血壓病、高血脂癥和糖尿病在痰濕質(zhì)患者中的發(fā)病率較高;(2)膽囊息肉(危險(xiǎn))組中,高血脂癥和高血壓病在痰濕質(zhì)患者中發(fā)病率較高;高血脂癥和脂肪肝在濕熱質(zhì)患者中發(fā)病率較高。(3)膽囊癌患者多見(jiàn)于老年女性、合并膽結(jié)石、濕熱質(zhì)和血瘀質(zhì)等特點(diǎn)的人群。
[Abstract]:Objective: To investigate the distribution of different diameter of polypoid lesions of the gallbladder and the relationship between the pathological properties of polypoid lesions of the gallbladder and the relationship between the physique of the gallbladder in order to provide ideas for the prevention and treatment of traditional Chinese medicine for polypoid lesions of the gallbladder. The healthy people of the physical examination center were used as the control group. The patients with polyposis of gallbladder polyps with diameter 8mm were used as the group of gallbladder polyps (non dangerous) and the patients with gallbladder polyps with diameter more than 8mm were used as the group of gallbladder polyps. The characteristics and differences of the physical distribution between the three groups were analyzed and compared, and the multiple polyps in the two groups of gallbladder polyps were studied. Whether the clinical examination results were specific, the relationship between the pathological properties and the constitution of the patients in the group of gallbladder polyps (dangerous), and the preliminary study of the distribution and correlation of the constitution of the patients with gallbladder cancer. Results: (1) the difference in the mean of 22 of the three groups of CHOL was statistically significant (P0.05); (2) in the group of gallbladder polyps (risk) The difference between the average LDL-C and the two groups of the gallbladder polyp (non dangerous) group and the control group was statistically significant (P0.05), but there was no significant difference between the gallbladder polyps (non dangerous) group and the control group (P0.05). (2) (1) the control group and the gallbladder polyp (non dangerous) group, the control group was significantly more distributed in the middle level and the mass (P0.0167); gallbladder polyp The distribution of qi deficiency in the (non dangerous) group was significantly more than that of the control group (P0.0167), and the distribution of phlegm wet quality in the group of gallbladder polyps (non dangerous) was significantly more than that of the control group (P0.0167), and there was no significant difference in the distribution of the remaining constitution between the two groups (P0.0167). (2) the distribution of the level and quality in the control group was significant between the group and the group of gallbladder polyps (dangerous). More than the gallbladder polyps (risk) group (P0.0167), the distribution of Zhongyang deficiency, phlegm, moisture and heat in the group of gallbladder polyps was more than that of the control group (P0.0167); the distribution of the remaining constitution between the two groups was not statistically significant (P0.0167). (3) gallbladder polyps (non risk) group and gallbladder polyp (dangerous) group, gallbladder polyp (dangerous) group (dangerous) group (risk) of the deficiency of the quality of the group. There was no significant difference in the distribution of gallbladder polyps (P0.0167). There was no significant difference in the distribution of the remaining constitution between the two groups (P0.0167). (3) the combination of the two groups of gallbladder polyps was compared, and the hyperlipidemia patients in the group of gallbladder polyps (dangerous) were significantly more than those of the gall bladder (non dangerous) group (P0.05). (4) gallbladder polyps (non dangerous) and gallbladder rest. The difference in the thickness of the gallbladder wall was statistically significant (P0.05). (5) (1) in the group of gallbladder polyps (non dangerous), the incidence of combined disease in patients with Qi deficiency was: hyperlipidemia (13.04%) = hypertension (13.04%) = fatty liver (13.04%) diabetes (8.7%) = hepatic cyst (8.7%) gallbladder (8.7%) Stone (4.35%); the incidence of combined disease in patients with phlegm and dampness were fatty liver (43.48%) hypertension (39.13%) hyperlipidemia (26.09%) diabetes (17.39%) liver cyst (13.04%) gallstone (4.35%); (2) gallbladder polyp (dangerous) group, the incidence of complication of hyperlipidemia (45.45%) hypertension (31.82%) diabetes (31.82%) diabetes mellitus (18.18%), respectively. Fatty liver (13.64%) = hepatitis B (13.64%) hepatic cysts (9.09%) gallstones (4.55%); the incidence of combined diseases in patients with humid heat were: hyperlipidemia (40%) fatty liver (25%) liver cyst (20%) = cholelithiasis (20%) hypertension (10%) = diabetes (10%) = hepatitis B (10%), and the incidence of hyperlipidemia in patients with hyperlipidemia (15.79%) liver cyst (10.53%), respectively. Hypertension (5.26%) = cholelithiasis (5.26%). (6) in the group of polyps of the gallbladder (dangerous), the physical distribution of the patients with cholesterol polyps was: phlegm wet (22.09%), Yang deficiency (18.6%) and damp heat (13.95%) Qi deficiency (11.63%); the distribution of the hyperplastic constitution of the gallbladder gland muscle was: Qi deficiency, phlegm and qi depression, and the physical distribution of the patients with adenomatous polyps. The condition was: Yang deficiency (36.36%) = damp heat (36.36%) phlegm and moisture content (18.18%) and blood stasis (9.09%) (7) of gallbladder cancer, 7 of gall bladder cancer, 77.78%; age 53~84 years, the average age of 69.22 years, 6 cases of acute hair authors, 66.7% and 88.89% (8/9) with cholelithiasis; B ultrasound or CT to obtain gallbladder cancer in 3 cases, 33.3%; tumor marker CA199 increase 5 cases, accounted for 55.56%, 5 cases of accidental gallbladder cancer, accounting for 55.56%, pathological type was mainly adenocarcinoma (7 cases), accounting for 77.78%, the tumor location was located in the body part (6 cases), accounting for 66.7%, and the physical types were divided into damp heat, blood stasis and Yang deficiency. Conclusion: (1) (1) the control group was distributed mainly in the flat and mass patients; (2) in the group of gallbladder polyps (non dangerous), Qi deficiency and phlegm wet quality (3) in the group of gallbladder polyps (dangerous), Yang deficiency, phlegm dampness and damp heat were the main distribution, and the patients with Yang deficiency were significantly more than the gallbladder polyps (non dangerous) group; (4) the phlegm moisture content was found in the patients with gallbladder polyps. (2) (1) in the group of gallbladder polyps (non dangerous), fatty liver, hypertension, hyperlipidemia and diabetes in phlegm dampness The incidence of hyperlipidemia and hypertension in patients with phlegm wet quality was higher in the group of gallbladder polyps (2). The incidence of hyperlipidemia and fatty liver in patients with damp heat was higher. (3) the patients with gallbladder cancer were often seen in the elderly women with the characteristics of gallstones, damp heat and blood stasis.
【學(xué)位授予單位】：安徽中醫(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)】：R273;R259

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9 王潤(rùn)華;膽囊癌易誤診[N];家庭醫(yī)生報(bào);2008年

10 本報(bào)記者 沙文茹;及早出擊 預(yù)防膽囊癌[N];中國(guó)消費(fèi)者報(bào);2003年

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