恶性腹腔积液中西医研究进展

A review on the effects of TCM and Western medicine on malignant peritoneal effusion

恶性腹腔积液(Malignant Peritoneal Effusion,MPE)是肿瘤晚期并发症,患者生活质量偏低。现代医学的治疗方法以对症治疗为主,临床受益有限。腹腔灌注药物临床效果明显,也是目前临床研究的重点。循环热灌注临床有效率较高,但仍有操作难度较大,存在继发感染、肠粘连等风险。《素问·阴阳应象大论篇》:“阳化气、阴成形。”张介宾对此注为“阳动而散,故化气;阴静而凝,故成形”。MPE是人体津液代谢异常,水液停聚腹部所致,导师李志刚教授从该理论出发,认为中医对MPE的治疗应基于温阳理论。从中医学角度来说,热疗属于温阳法。运用热疗治疗MPE是用“阳化气”抑制“阴成形”的过程,即平调阴阳失衡。神阙穴是气机升降的总枢,热主散,能行气,对神阙穴热疗能够激发脏腑经脉气血的运行,从而治疗津液输布代谢障碍。导师李志刚教授在传统中医温阳理论指导下,受中药外敷及艾灸治疗启发,结合现代肿瘤治疗方法,总结改进出的“三剑客”疗法,即抗血管生成药物、化疗药物腹腔灌注、微波体外深部热疗神阙穴。文章将从导致MPE发病的病因、发病机制、现代医学治疗方法以及中医药的认识及治疗等方面论述MPE治疗的研究进展。

Malignant peritoneal effusion is a late complication of tumor,and the quality of life of patients is low.The treatment methods of modern medicine mainly focus on symptomatic treatment with limited clinical benefit.Intraperitoneal infusion has obvious clinical effects and is also the focus of clinical research.The clinical efficiency of circulating thermoperfusion is relatively high,but it is still difficult to operate,and there are risks of secondary infection and intestinal peritoneal.Suwen,Yinyang Yingxiang Dalun Pian(《素问·阴阳应象大论篇》)elaborates the relationship between Yin and Yang,namely“Yang transforms Qi(气)and Yin(阴)takes shape”.ZHANG Jiebin explains that“Yang moves and disperses,thus transforms Qi;Yin is static and coagulative,so it takes shape”.Malignant peritoneal effusion is caused by abnormal body fluid metabolism and the accumulation of water and fluid in the abdomen.Based on this theory,Professor LI Zhigang,the supervisor,believes that the treatment of malignant peritoneal effusion should be based on warming Yang theory.From the point of view of TCM,heat therapy belongs to warming Yang method.The application of hyperthermia in the treatment of malignant peritoneal effusion is the process of suppressing Yin forming into mass with“yangqi”,that is,to adjust the imbalance of Yin and Yang.Shenque acupoint(RN8)is the total pivot of Qi lifting and heat scattering,it can help to regulate Qi,heat therapy at Shenque acupoint can stimulate the operation of internal organs,channels,Qi and blood,so as to treat body fluid distribution metabolic disorders.Under the guidance of warming Yang theory of traditional Chinese medicine,inspired by external application of TCM medicine and moxibustion treatment,and combined with modern tumor treatment methods,Professor LI Zhigang summarizes and improves the“Three Squiremen”therapy,namely,peritoneal perfusion of anti-angiogenesis drugs,chemotherapy drugs,microwave in vitro deep heat therapy at Shenque acupoint.This article will discuss the research progress in the treatment of malignant peritoneal effusion from the aspects of etiology,pathogenesis,modern medical treatment and the understanding and treatment of traditional Chinese medicine.