【摘要】：目的:胃息肉是胃黏膜局部隆起性病變,近年來檢出率呈上升趨勢,治療原則主張發(fā)現(xiàn)息肉均應(yīng)手術(shù)切除,尤其是切除腺瘤性息肉,來預(yù)防和減少癌變的發(fā)生。但是,由于胃息肉存在一定的復(fù)發(fā)性,大多數(shù)患有胃息肉的患者需反復(fù)進(jìn)行消化道內(nèi)鏡下息肉切除。因此,本研究通過觀察胃息肉的臨床表現(xiàn)、病理類型及其相關(guān)性等,結(jié)合中醫(yī)辨證論治,預(yù)防及治療胃息肉,進(jìn)以指導(dǎo)臨床,降低胃息肉的復(fù)發(fā)率,從而有效降低胃惡性腫瘤的發(fā)生率,為中醫(yī)治療胃息肉提供新思路。方法:選取2015年11月至2017年2月北京中醫(yī)藥大學(xué)東直門醫(yī)院脾胃科門診符合納入標(biāo)準(zhǔn)患者共67例,其中剔除12例,失訪15例,最終療效評價42例。建立胃息肉臨床資料調(diào)查表,對符合納入標(biāo)準(zhǔn)并同意參與本次調(diào)查的患者收集一般資料、胃鏡結(jié)果、病理診斷結(jié)果及中醫(yī)四診資料,填寫病例臨床療效觀察表。根據(jù)中醫(yī)整體辨證論治的原則,對符合納入標(biāo)準(zhǔn)的患者予散結(jié)散加減合西黃膠囊治療。散結(jié)散組成:生龍牡各15g,海蛤殼15g,膽南星6g,皂角刺10g,連翹6g(北京康仁堂藥業(yè)有限公司生產(chǎn)的免煎顆粒,每日一劑,分2次口服)。西黃膠囊(陜西愛民藥業(yè),規(guī)格每粒裝0.25g,用法用量一次4粒,一日2次),療程3個月,觀察期為1年。分別于治療前、治療后1年行胃鏡檢查;于治療前、治療后三個月進(jìn)行癥候?qū)W評分記錄。觀察記錄患者用藥前后的臨床癥狀及嚴(yán)重程度評分;觀察記錄治療前后胃鏡檢查結(jié)果及活體組織病理診斷結(jié)果。結(jié)果:在本研究中收集達(dá)到入選標(biāo)準(zhǔn)的胃息肉患者共42例,男性13例,女性29例,男女比例為1:2.23,女性患者明顯多于男性,其中年齡最小34歲,最大75歲,平均年齡56.92±9.96歲,≥60歲患者多發(fā)。胃鏡資料中息肉數(shù)目單發(fā)者12例,占28.6%,多發(fā)者30例,占71.4%。息肉生長部位以胃體多見,其次是胃底、胃竇。息肉形態(tài)以山田Ⅱ型(占40.5%)和山田Ⅲ型(占31%)多見。息肉直徑最小0.2cm,最大1.0cm,平均直徑0.42±0.19cm,其中以0.3-0.6cm為主,占81%。病理類型依次為胃底腺息肉19例(占45.2%),腺瘤性息肉2例(占4.8%),增生性息肉6例(占14.3%),炎性息肉15例(占35.7%)。在治療結(jié)束時,中醫(yī)癥狀積分前后比較:治療前積分19.52±7.74,治療后積分2.67±1.69。臨床痊愈15例,占35.7%;顯效20例,占47.6%,有效5例,占11.9%;無效2例,占4.8%;總有效40例,占95.2%。通過胃鏡資料的統(tǒng)計分析發(fā)現(xiàn),對42例患者經(jīng)定期隨訪后,僅有3例患者在1年后復(fù)發(fā),治療總有效率為93%,復(fù)發(fā)率為7%。研究結(jié)論:1胃息肉發(fā)病以中老年人群多見,女性發(fā)病率明顯高于男性;2本研究發(fā)現(xiàn)胃息肉以多發(fā)多見,息肉生長部位以胃體多見,其次是胃底、胃竇。息肉直徑以0.3-0.6cm為主。息肉形態(tài)以山田Ⅱ型和山田Ⅲ型多見。病理類型依次以胃底腺息肉和炎性息肉為主。3散結(jié)散合西黃膠囊口服的方法,總體治療效果顯著,胃息肉切除術(shù)后的患者在經(jīng)治療后,其復(fù)發(fā)率下降。
[Abstract]:Objective: gastric polyp is a local protuberant lesion of gastric mucosa. The detection rate of gastric polyp is increasing in recent years. The principle of treatment is that the polyp should be removed by surgery, especially the adenomatous polyp, in order to prevent and reduce the occurrence of carcinogenesis. However, due to the recurrence of gastric polyps, most patients with gastric polyps need repeated endoscopic resection of gastrointestinal polyps. Therefore, by observing the clinical manifestations, pathological types and their correlation of gastric polyps, combined with TCM differentiation of symptoms and signs, the prevention and treatment of gastric polyps can guide the clinical practice and reduce the recurrence rate of gastric polyps. It can effectively reduce the incidence of gastric malignant tumors and provide a new idea for the treatment of gastric polyps. Methods: from November 2015 to February 2017, 67 patients were selected from the Department of spleen and stomach of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine, including 12 cases excluded, 15 cases lost, and 42 cases were evaluated. To establish a clinical information questionnaire for gastric polyps, to collect general information, gastroscopy results, pathological diagnosis results and four diagnostic data of TCM for patients who meet the inclusion criteria and agree to participate in this investigation, and to fill out the observation form of clinical efficacy of cases. According to the principle of syndrome differentiation and treatment of TCM, the patients who meet the inclusion criteria were treated with Sanjie Powder plus subtraction and Xihuang capsule. Sanjie Powder composition: Shenglong Peu 15g, sea clam shell 15g, Dannanxing 6g, Saphanjiao 10g, Forsythia 6g (Beijing Kangrentang Pharmaceutical Co., Ltd., one dose per day, divided into 2 oral). Xihuang capsule (Shaanxi Aimin pharmaceutical industry, specification 0.25 g per pill, usage dosage of 4 capsules once, twice a day), the course of treatment is 3 months, the observation period is 1 year. Gastroscopy was performed before treatment and 1 year after treatment, and symptom score was recorded before treatment and 3 months after treatment. The clinical symptoms and severity scores of the patients before and after treatment were observed and the results of gastroscopy and pathological diagnosis of living tissues were observed before and after treatment. Results: a total of 42 patients with gastric polyps were collected in this study, including 13 males and 29 females. The ratio of male to female was 1: 2.23. The number of female patients was significantly higher than that of male patients, the youngest 34 years old, the maximum 75 years old, the average age 56.92 鹵9.96 years. More than 60 years old patients. There were 12 cases (28.6%) with single polyps and 30 cases (71.4%) with multiple polyps. Polyp growth site in the gastric body, followed by the gastric fundus, gastric antrum. The polyps were more common in Yamada 鈪，

本文編號：2263339