原发性肝癌中医四种分型系统预后判断和治疗的指导价值比较

Comparison of guiding values of four types of Chinese medicine classification system for prognosis and treatment of primary hepatocellular carcinoma

目的:比较4种中医分型系统(刘氏六分法,郁氏四分法,李氏四分法及钱氏四分法)对原发性肝癌预后判断和中医治疗的指导价值。方法:采用前瞻性研究,分析2005～2006年在外院行经肝动脉化疗栓塞术(transcatheter arterial chemoembol ization,TACE)后来我院行辅助治疗的104例原发性肝癌患者的临床资料,分别按四种分型系统进行中医分型,比较各型患者的生存情况以及中医治疗对其生存期的影响。结果:在判断预后方面,郁氏及钱氏四分法各亚型间生存率差异均有统计学意义(P<0.05),而刘氏六分法及李氏四分法的一些亚型间生存率差异无统计学意义(P>0.05);在指导中医治疗上,郁氏、李氏及钱氏分型的前三亚型患者在TACE后辅以血府逐瘀汤和大黄庶虫丸行气散结,化痞消积治疗者生存率优于单纯TACE治疗者,而第四亚型TACE后是否辅以中医治疗对生存率影响差异无统计学意义(P>0.05)。结论:对于原发性肝癌,郁氏及钱氏四分法能较好的判断预后及指导临床中医治疗。

Objectives：To compare the guiding value of four types of Chinese medicine classification system（Liu′ s Six Categories,Yu′ s Four Categories,Li′ s Four Categories and Qian′ s Four Categories） for prognosis and diagnosis of primary hepatocellular carcinoma.Methods：Using prospective study,to analyze the clinical data of 104 cases of primary hepatocellular carcinoma receiving the auxiliary therapy in our hospital after the surgery of transcatheter arterial chemoembolization（TACE） during the period of 2005-2006.The cases were classified respectively according to above four types of Chinese medicine classification system.The survival status of the patients with various types and the influence of Chinese medicine treatment to their survival periods were compared.Results：In terms of prognosis,the survival rate differences among subtypes of Yu′ s Four Categories and Qian′ s Four Categories were statistically significant,while those among subtypes of Liu′ s Six Categories and Li′ s Four Categories were not the case.In terms of guiding Chinese medicine treatment,three subtypes of the patients of Yu′ s Four Categories,Li′ s Four Categories and Qian′ s Four Categories were given the auxiliary therapy using Xuefuzhuyu Decoction together Dahuangshuchong Pills for promoting the Qi circulation,dispelling nodes,relieving and eliminating mass after TACE.The survival rate of promoting the Qi circulation,dispelling nodes,relieving and eliminating mass was better than that of pure TACE treatment.But whether using Chinese medicine or not after TACE in the fourth subtype had no difference in the survival rate.Conclusion：For primary hepatocellular carcinoma,Yu′ s Four Categories and Qian′ s Four Categories can better judge the prognosis and guide the treatment of clinical Chinese medicine.