58例肝癌患者手术前后中医复合证证候特点初步研究

A preliminary study on TCM compound syndrome characteristics of 58 patients with liver cancer before and after operation

目的:通过观察原发性肝癌患者手术前后中医复合证证候分布与转变情况,初步揭示肝癌患者手术前后的中医复合证证候变化特点,为手术后肝癌的辨证论治提供科学依据。方法:参照《中药新药临床研究指导原则》建立肝癌中医复合证证候定性和量化诊断标准,采用自身前后对照的方法,对58例肝癌手术患者手术前后中医复合证证候特点进行初步研究。结果:中医复合证证候分布及变化情况:肝癌患者手术前肝血瘀阻证、湿热内蕴证所占比例较高,分别为22.1%、20.9%;肝癌患者手术后以湿热内蕴证、脾气虚弱证所占比例较高,分别为21.8%、21.0%;手术后肝血瘀阻证减少,脾气虚弱证增多,两者手术前后差异有统计学意义(P<0.05);其余各证手术前后差异无统计学意义(P>0.05)。中医复合证证候量化评分结果:肝癌患者手术前量化评分最高的两个证候是:湿热内蕴证22.66分、脾气虚弱证17.75分;手术后量化评分最高的两个证候是:脾气虚弱证24.98分、湿热内蕴证23.31分;手术后肝血瘀阻证减少,脾气虚弱证增多,两者手术前后差异有统计学意义(P<0.05);其余各证手术前后差异无统计学意义(P>0.05)。结论:肝癌患者手术前后均呈现肝血瘀阻证和脾气虚弱证的症状,因此需重视活血化瘀、健脾益气,但术后肝血瘀阻证有所减少,脾气虚弱证增多,应该对活血化瘀和健脾益气力度有所调整,肝癌术后中医辨证论治应更重视健脾益气。肝癌患者手术前后湿热内蕴证均较多,手术前后变化无差异,故肝癌患者手术前后均应重视清热利湿。

Objective： To observe the distribution and change circumstances of TCM compound syndrome of primary liver cancer patients before and after operation, reveal the changes characteristics of compound syndrome and provide an objective basis for TCM syndrome differentiation and treatment after operation. Methods： Referring to the Guiding Principle of Clinical Study of TCM to establish the qualitative and quantitative diagnostic criteria of TCM compound syndrome and using self contrast meth- od, TCM compound syndrome characteristics of the 58 patients with liver cancer before and after operation were studied. Results： The distribution and change of compound syndromes： there were a large proportion of hepatic blood stagnation and damp-heat brewing syndromes before operation, the proportion was respectively 22. 1% , 20. 9%. After operation damp-heat brewing and spleen deficiency syndromes, was respectively 22. 8% , 21.0%. After operation hepatic blood stagnation syndrome decreased, spleen deficiency syndrome increased compared with these before operation, there was statistically difference between before and after operation （ P 〈 0. 05 ） . There were no statistical difference in terms of other syndromes between before and after operation （P 〉 0. 05 ） . The result of quantized integration ： the two highest compound syndromes of quantized integration were damp-heat brewing syndrome 22. 66 and spleen deficiency syndrome 17. 75 before operation, spleen deficiency syndrome 24.98 and dampheat brewing syndrome 23.31 after operation. Hepatic blood stagnation syndrome decreased, spleen deficiency syndrome increased after operation, there was statistically difference between before and after operation （P 〈 0. 05 ） . There were no statistical difference in terms of other syndromes before and after operation （P 〉 0. 05） . Conclusion ： The patients with liver cancer present the symptoms of hepatic blood stagnation and spleen deficiency syndromes before and after operation. So it＇s necessary to pay attention to promoting blood circulation and removing blood stasis, strengthening spleen and replenishing Qi. Hepatic blood stagnation syndrome decreased, spleen deficiency syndrome increased after operation; We should adjust the syndrome characteristics after operation to. promoting blood circulation and removing blood stasis, strengthening spleen and replenishing Qi. The syndrome differentiation and therapeutic methods of TCM should pay attention to strengthening spleen and replenishing Qi at the same time after operation. The patients with liver cancer present the symptoms of damp-heat brewing before and after operation, but there are no statistical difference before and after operation. Therefore we should pay attention to eliminating dampness and heat before and after operation.