【摘要】：目的本研究采用靳三針療法中的“足三針”穴組治療結(jié)直腸癌術(shù)后出現(xiàn)的胃腸動(dòng)力障礙,結(jié)合對(duì)病人病變組織miR-222含量的對(duì)比,嘗試探索針刺足三針對(duì)恢復(fù)胃腸活動(dòng)的相關(guān)機(jī)制。臨床研究采用一般對(duì)癥治療與針刺治療進(jìn)行對(duì)照,目的在于證明針刺治療比單純一般對(duì)癥治療有優(yōu)越性。同時(shí),通過(guò)比較病變組織miR-222的含量,推導(dǎo)針刺起效的機(jī)制與microRNAs的關(guān)系。臨床研究嚴(yán)格按照隨機(jī)對(duì)照原則進(jìn)行,可為研究針刺治療結(jié)直腸癌術(shù)后胃腸動(dòng)力障礙的相關(guān)機(jī)制提供有力的循證醫(yī)學(xué)支持。方法選取符合納入標(biāo)準(zhǔn)的結(jié)直腸癌術(shù)后患者32例,根據(jù)排除標(biāo)準(zhǔn)排除6例,然后按照隨機(jī)數(shù)表法隨機(jī)分為治療組與空白對(duì)照組。對(duì)照組在術(shù)后單純給予一般對(duì)癥治療；治療組則在此基礎(chǔ)上,于術(shù)后患者清醒且下肢感覺(jué)恢復(fù)后即開(kāi)始加用針刺治療,選穴以足三針為主(足三里、三陰交、太沖),最長(zhǎng)針刺5天。治療過(guò)程中兩組分別剔除1例,故最后24例進(jìn)入評(píng)估(每組12例)。觀察術(shù)后第一次排氣、排便及拔除胃管的時(shí)間；術(shù)后腹痛、腹脹情況；在對(duì)照組留取8例癌組織和治療組留取4例癌組織進(jìn)行miR-222相對(duì)表達(dá)量檢測(cè)。結(jié)果1.術(shù)后第一次肛門(mén)排氣比較：對(duì)照組與治療組的差異具有顯著性(p0.01),治療組的首次排氣時(shí)間更短；2.術(shù)后第一次肛門(mén)排便比較：對(duì)照組與治療組的差異具有顯著性(p0.01),治療組的首次排便時(shí)間更短；首次排便情況(是否成形),治療組與治療組的差異無(wú)顯著性(p0.05)；3.拔除胃管時(shí)間比較：對(duì)照組與治療組的差異具有顯著性(p0.01),治療組的拔除胃管時(shí)間更短；4.腹痛評(píng)級(jí)比較：治療組的前后評(píng)分差值與對(duì)照組相比有顯著差異(p0.01),提示治療組在腹痛改善方面療效更佳；5.腹脹評(píng)級(jí)比較：治療組的前后評(píng)分差值與對(duì)照組相比有顯著差異(p0.01),提示治療組在腹脹改善方面療效更佳；6.組織miR-222的相對(duì)表達(dá)量比較：對(duì)照組與治療組的癌組織miR-222含量無(wú)明顯差異(p0.05)；癌旁組織與癌組織的miR-222含量有明顯差異(p0.05),癌組織中的含量更多；7.療效評(píng)級(jí)比較：對(duì)照組與治療組的差異具有顯著性(p0.01),治療組的療效更佳；8.miR-222與療效評(píng)級(jí)的關(guān)系分析：雖然有趨勢(shì)顯示miR-222含量越低,針刺療效及自然預(yù)后越好,但統(tǒng)計(jì)未有意義,可能與所收集的標(biāo)本量較少有關(guān)。結(jié)論1.在一般支持治療的基礎(chǔ)上,針刺足三針能縮短結(jié)直腸癌術(shù)后患者的首次排氣、排便及拔除胃管的時(shí)間,并有較好的緩解腹痛、腹脹癥狀的效果；2.miR-222在結(jié)直腸癌病人的病理組織中普遍存在,且其含量較正常組織更多；3.miR-222的高表達(dá)可能影響結(jié)直腸癌術(shù)后胃腸動(dòng)力恢復(fù)和針刺療效,尚需加大樣本量進(jìn)行研究。
[Abstract]:Objective to study the effect of Jin's three-needle therapy on gastrointestinal motility in patients with colorectal cancer after operation, and to compare the content of miR-222 in pathological tissues of patients with colorectal cancer. This paper attempts to explore the mechanism of acupuncture for the recovery of gastrointestinal activity. The aim of clinical study is to prove that acupuncture therapy is superior to simple general symptomatic therapy. At the same time, by comparing the content of miR-222 in diseased tissues, the relationship between the mechanism of acupuncture and microRNAs was deduced. The clinical study is carried out strictly according to the principle of random control, which can provide evidence-based medical support for the study of the mechanism of gastrointestinal motility disorder after colorectal cancer treatment by acupuncture. Methods 32 patients with colorectal cancer were selected and 6 patients were excluded according to the exclusion criteria. Then they were randomly divided into treatment group and blank control group according to the method of random number table. The control group was treated with general symptomatic therapy only after operation. On this basis, the patients in the treatment group began to be treated with acupuncture after the patients were awake and the lower limb sensation recovered. The main acupuncture points were three acupuncture points (Zusanli, Sanyinjiao, Taochong), and the longest acupuncture was 5 days (Zusanli, Sanyinjiao, Taicong). In the course of treatment, 1 case was excluded in the two groups, so 24 cases were evaluated (12 cases in each group). The time of first exsufflation, defecation and extubation of stomach tube, abdominal pain and distension after operation were observed. The relative expression of miR-222 was detected in 8 cancer tissues in the control group and 4 cancer tissues in the treatment group. Result 1. Comparison of the first anal exhaust after operation: the difference between the control group and the treatment group was significant (p0.01), the first exhaust time of the treatment group was shorter; 2. Comparison of the first anal defecation after operation: the difference between the control group and the treatment group was significant (p0.01), the first defecation time of the treatment group was shorter than that of the control group. There was no significant difference between the treatment group and the treatment group (p0.05). Comparison of the time of extubation: the difference between the control group and the treatment group was significant (p0.01), the time of removing gastric tube was shorter in the treatment group; 4. Comparison of abdominal pain rating: the difference between the treatment group and the control group was significant (p0.01), suggesting that the treatment group is better in improving abdominal pain; 5. Abdominal distension rating comparison: the difference between the treatment group and the control group was significant (p0.01), suggesting that the treatment group in abdominal distension improvement effect is better; 6. Comparison of the relative expression of miR-222: there was no significant difference in miR-222 content between the control group and the treatment group (p0.05), but there was a significant difference in the miR-222 content between the adjacent tissues and the cancerous tissue (p0.05), and the content of miR-222 in the cancer tissue was more than that in the control group (p0.05). 7. Comparison of curative effect rating: the difference between the control group and the treatment group was significant (p0.01), and the curative effect of the treatment group was better than that of the control group. Analysis of the relationship between 8.miR-222 and efficacy rating: although there is a tendency to show that the lower the miR-222 content, the better the acupuncture effect and the natural prognosis, but the statistical significance is not significant, which may be related to the small amount of samples collected. Conclusion 1. On the basis of general supportive treatment, acupuncture of foot three needles can shorten the time of first exhaust, defecation and extubation of patients with colorectal cancer after operation, and has a better effect of relieving abdominal pain and abdominal distension. 2.miR-222 is prevalent in the pathological tissues of colorectal cancer patients, and its content is more than that in normal tissues. The high expression of 3.miR-222 may affect the recovery of gastrointestinal motility and the effect of acupuncture after colorectal cancer.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R246.5

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