加味六磨汤治疗妇科恶性肿瘤患者术后肠梗阻的临床观察

Clinical Observation on Gynecological Malignant Tumor Intestinal Obstruction by Modified Liumo Decoction(加味六磨汤)

目的:探讨加味六磨汤治疗妇科恶性肿瘤患者术后肠梗阻的临床疗效。方法:选取妇科恶性肿瘤患者术后肠梗阻72例,随机法分为对照组和治疗组,各36例。两组均予一般对症处理,对照组再予开塞露灌肠,治疗组再予加味六磨汤灌肠治疗。观察两组治疗后首次肛门排气时间及排便时间,比较两组治疗前、术后1 d、5 d时患者血浆胃动素(MLT)及血管活性肠肽(VIP)的变化。评估其生活质量及临床疗效。结果:总有效率对照组69.4%,治疗组88.9%,组间差异有统计学意义(P<0.05)。对照组生活质量改善率、稳定率、恶化率依次为16.7%、50.0%、33.3%,治疗组生活质量改善率、稳定率、恶化率依次为38.9%、50.0%、11.1%;治疗组生活质量改善率高于对照组(P<0.05),而恶化率低于对照组(P<0.05)。治疗组患者首次肛门排气时间及排便时间均明显早于对照组,组间差异有统计学意义(P<0.01)。治疗组血浆MLT水平呈逐渐上升趋势,组内差异有统计学意义(P<0.05);而对照组术后1 d时患者血浆MLT水平呈峰值,分别与同组治疗前、术后5 d比较,差异有统计学意义(P<0.05)。对照组血浆VIP水平呈逐渐上升趋势,组内差异有统计学意义(P<0.05);而治疗组术后1 d时患者血浆MLT水平呈峰值,分别与同组治疗前、术后5 d比较,差异均有统计学意义(P<0.05)。术后5 d治疗组患者血浆MLT水平高于对照组(P<0.05),而VIP水平低于对照组(P<0.05)。结论:加味六磨汤治疗妇科恶性肿瘤患者术后肠梗阻,临床疗效显著,其作用机制可能与调节患者血浆中MLT、VIP水平相关;同时能有效改善患者生活质量。

Objective： To investigate the clinical effect of Modified Liumo Decoction in the treatment of patients with gynecological malignant tumor intestinal obstruction. Methods： The 72 cases of patients with gynecological malignant tumor postoperative intestinal obstruction were randomly divided into control and treatment groups, 36 cases in each. The patients were given general symptomatic treatment in two groups, and the patients were given Enema Glycerini enema in control group. The patients were given Modified Liumo Decoction in treatment group. The two groups were observed after treatment for the first time, anal exhaust time and defecation time. The plasma motilin（MLT） and vasoactive intestinal peptide（VIP） changes were compared between the two groups before treatment, postoperative 1 d and 5 d. The quality of life and clinical efficacy were evaluated.Results： The total effective rate was 69.4% in the control group and 88.9% in treatment group, and the difference on total effective rate was statistically significant（P〈0.05）. The life quality improvement rate, stable rate,deterioration rate were respectively 16.7%, 50.0% and 33.3% in the control group, and 38.9%, 50.0% and11.1% in treatment group; The treatment group showed higher life quality improvement rate than the control group（P〈0.05）, while lower deterioration rate than the control group（P〈0.05）. The treatment group showed earlier first anal exhaust time and defecation time than the control group, and there was significant difference between the two groups（P〈0.01）. The treatment group showed a gradual upward trend of MLT, and the difference was statistically significant（P〈0.05）; The control group of patients after 1 d plasma MLT levels in patients with peak, respectively, with the same group before and after treatment of 5 d was statistically significant（P〈0.05）.The plasma VIP level was increased gradually in the control group, the group difference was statistically significant（P〈0.05）; while the treatment group of patients after 1 d plasma MLT levels in patients with peak, respectively, with the same group before and after treatment of 5 d was statistically significant（P〈0.05）. The treatment group showed higher level of plasma MLT than the control group in 5 d（P〈0.05）, while lower VIP level than the control group（P〈0.05）. Conclusion： The Modified Liumo Decoction shows clinical curative effect on gynecological malignant tumor postoperative ileus; its mechanism may be related to the regulation of MLT and VIP levels in plasma of patients; at the same time it can effectively improve the quality of life of patients.