乳腺癌围手术期患者中医证型及转化规律的临床研究

Clinical Study on TCM Syntromes and Transformation Pattern in Breast Cancer Patients During Perioperative Period

目的:探讨乳腺癌围手术期患者中医证型及转化规律,为临床诊疗提供客观依据奠定基础。方法:对乳腺癌围手术期患者采用文献调研、设计临床证候信息采集表,运用聚类分析等方法得出不同时点中医证型分类及转化规律。结果:聚三类较切合临床实际。经专家讨论确定各证型名称是:术前1天为肝郁痰凝兼肾虚,肝郁血瘀及冲任失调兼肝郁;术后第1天为脾胃虚弱,气阴两虚,湿困脾胃;术后第3天为脾胃虚弱,湿困脾胃,气血两虚;术后第6天为脾胃虚弱,气阴两虚,湿困脾胃。结论:初步制定乳腺癌围手术期中医辨证分型,术前到术后中医证型变化总体是由实走向虚证,术前以肝郁痰凝血瘀最常见;术后以脾胃虚弱、湿困脾胃为常见;术后患者随着时间延长,脾胃虚弱及湿困脾胃证渐增,而气阴(血)两虚证渐减。

Objective：To probe the TCM Syntromes and transformation pattern in breast cancer patients during perioperative period,in order to provide an objective basis for clinical treatment to lay the foundation. Methods：Researching on the breast cancer patients in perloperative period, using the literature research and the clinical syndromes information form, by clustering analysis on the TCM Syntromes and transformation pattern in different time. Results：The Syntromes are most practical to be clustered into 3 classes： in the day before surgery, they are liver Qi depression and phlegm stasis with kidney deficiency ,liver Qi depression with blood stasis, and disproportion of Chu and Ren meridian with liver Qi de- pression; in the day after surgery, they are hypofunctioning of spleen and stomach, deficiency of both Qi and blood and dampness disturbing spleen and stomach;in third day after surgery, they are hypofunetioning of spleen and stomach, deft-ciency of both Qi and Yin, or dampness disturbing spleen and stomach. Conclusions ： The syndrome differentiated standard for perioperative period of breast cancer patients was primarily established. As the period from preoperatively to post- operatively, the syndrome change from excess to deficiency. The preoperatively syndrome is liver Qi depression and phlegm stasis with blood stasis mostly while the postoperatively syndrome is hypofunctioning of spleen and stomach or dampness disturbing spleen and stomach mosdy. As the postoperative time passing, the Qi deficiency in spleen and stomach and dampness disturbing spleen and stomach is increasing, and the deficiency of both Qi and Yin is decreasing.