加减黄芪防己汤在喉癌术后放疗引起的迟发性淋巴水肿中的应用

Application of Modified Huangqi Fangji Decoction in Radiotherapy Induced Delayed Lymphedema after Laryngocarcinoma Surgery

目的探讨加减黄芪防己汤在喉癌术后局部放疗引起的迟发性淋巴水肿治疗中的效果。方法将60例喉癌手术后放疗患者分为中药治疗组和对照组,每组30例,每组包括20例部分喉切除及10例全喉切除病例,对照组中有13例行颈淋巴结清扫,术后仅予常规调强放疗。中药治疗组有16例行颈淋巴结清扫,术后行调强放疗同时给予黄芪防己汤加减,每日1剂,分2次口服,中药疗程为10周。放疗结束1个月后,利用改良Miller和LENT-SOMA评分系统分别对各组放疗引起的喉及颈部的迟发性淋巴水肿进行评估,采用视觉量表(VAS)对患者的生活质量进行评估。结果与对照组比较,中药治疗组喉及颈部迟发性淋巴水肿的反应分级明显降低(P<0.01,P<0.05),VAS分值亦降低(P<0.01)。结论加减黄芪防己汤能有效地预防和减轻放疗引起迟发性淋巴水肿反应。

Objective To study the effect of modified Huangqi Fangji Decoction （HQFJD）in the treatment of radiotherapy induced delayed lymphedema after laryngocarcinoma surgery. Methods Totally 60 patients with laryngeal squamous cell carcinoma were assigned to the Chinese medicine （CM） treatment group and the control group, 30 in each group （consisting of 20 partial laryngectomy and 10 total laryngectomy）. Thirteen patients in the control group received neck dissection. They received routine intensity-modulated radiation therapy. Sixteen patients in the CM treatment group received neck dissection. They received routine intensity modulated radiation therapy while taking modified HQFJD （one dose per day, taken in two times）. The therapeutic course for HQFJD was 10 weeks. The effects of HQFJD on late lymphedema of larynx and neck induced by radiotherapy were assessed by Modified Miller and LENTSOMA score system at 1 month after radiotherapy. Patient＇s quality of life （QOL） was assessed by visual analogue scale （VAS）. Results Compared with the control group, the response grading of late lymphedema of larynx and neck was obviously lower （P 〈 0.01, P 〈 0.05）, and VAS score also de- creased in the CM treatment group （P 〈0.01 ）. Conclusion Modified HQFJD could effectively prevent and attenuate radiotherapy induced delayed lymphedema.