直肠灌注莪黄汤在低位直肠癌新辅助放疗期的临床应用

Clinical Application of Rectal Perfusion with Ehuang Decoction in Neoadjuvant Radiotherapy of Low Rectal Cancer

目的探讨经直肠灌注自拟"莪黄汤"对低位直肠癌在新辅助治疗围放疗期的临床应用价值。方法选择Ⅲ期,肿瘤距齿状线2～6 cm,已失去Ⅰ期手术机会的低位直肠癌患者36例,随机分为3组。对照组:仅行新辅助放疗;治疗组A:"莪黄汤"直肠灌注1 W+新辅助放疗;治疗组B:"莪黄汤"直肠灌注2 W+新辅助放疗。观察其临床表现、肠镜内观、大便潜血的变化。结果对照组患者临床表现变化不明显,甚至有加重。肠镜显示肿块缩小,但周围粘膜组织充血、水肿明显。大便潜血阳性率(6/12);治疗组A患者临床表现明显减轻。肠镜显示肿块缩小,周围粘膜组织未见明显充血、水肿。大便潜血阳性率(1/12);治疗组B患者临床表现基本消失。肠镜显示肿块明显缩小,周围粘膜组织未见充血、水肿,肿块与周围组织界限渐清。大便潜血阳性率(1/12)。结论在低位直肠癌新辅助放疗期联合应用经直肠灌注自拟"莪黄汤",可明显改善患者的临床表现,改善肿瘤周围组织手术条件,增强新辅助治疗效果,缩短了新辅助治疗的时间,提高患者的生活质量。

Objective： To probe into the practical value of rectal perfusion with Ehuang deocoction in neoadjuvant radiotherapy of low rectal cancer. Methods： 36 patients with low rectal cancer were randomly divided into 3 groups. Those patients were in phase Ⅲ with tumors 2 to 6 cm from dentate line, and had lost the chance for surgery in phase I. The control group accepted neoadjuvant radiotherapy only, therapeutic group A was treated with rectal perfusion with Ehuang decoction for one week and neoadjuvant radiotherapy, and therapeutic group B was treated with rectal perfusion with Ehuang decoction for two weeks plus neoadjuvant radiotherapy. The changes of the clinical symptoms, enteroscopy and fe- cal occult blood were observed. Results： The clinical symptoms of the patients in the control group had little change, some of them even worsened. Enteroscopy showed that tumor became smaller, but mueosa had obvious congestion and edema. 6/12 of the patients had positive fecal occult blood test. The clinical symptoms of the therapeutic group A lessened obviously. Enteroseopy showed that tumor became smaller, and no mucous congestion or edema was found. The positive rate of fecal occult blood test was 1/12. The clinical symptoms of the patients in therapeutic group B almost disappeared. Enteroscopy showed obvious shrink of the tumor, no mucous congestion or edema, the boundary between tumor and surrounding tissues was clear. The positive rate of fecal occult blood test was 1/12. Conclusion： Rectal perfusion with Ehuang decoction in neoadjuvant radiotherapy of low rectal cancer can significantly improve the clinical manifestation, enhance surgical conditions of the surrounding tissues, strengthen the therapeutic effects of neoadjuvant therapy, and improve the life quality of the patients.