基于伏毒病机探讨结直肠腺瘤术后复发的防治思路

Exploration of the Thoughts for the Prevention and Treatment of Postoperative Recurrence of Colorectal Adenoma Based on the Pathogenesis of Latent Toxin

结直肠腺瘤是结直肠癌的重要癌前病变,现代医学即使采用内镜下摘除腺瘤后仍存在较高的复发率,目前尚无疗效确切的预防手段。中医药通过辨病与辨证相结合以预防结直肠腺瘤术后复发,具有有效缓解临床症状、降低复发率、提高患者生活质量等优势。本课题组认为,结直肠腺瘤术后患者脾失健运,痰阻气滞,痰湿结聚于胃肠,久而成瘀,痰湿瘀胶结于肠道,成为伏毒,遇诱因毒邪易再发,复聚成瘤;治疗以“清解伏毒”为大法,用药以健脾益气为本,辅以理气化湿行瘀、解毒消瘤,并基于临床实践拟定防治结直肠腺瘤复发的基础方“调肠消瘤方”(主要由党参、白术、黄芪、白花蛇舌草、炙甘草等药物组成),可为临床防治结直肠腺瘤术后复发提供思路。

Colorectal adenoma is the important precancerous lesion of colorectal cancer,and it still remains a high recurrence rate even after endoscopic removal of adenoma in the field of modern medicine.Till now,there are no proven preventive measures.Traditional Chinese medicine for preventing the postoperative recurrence of colorectal adenoma has the advantages of effectively relieving clinical symptoms,reducing the recurrence rate and improving the quality of life of the patients by following the principles of treatment based on disease differentiation and syndrome differentiation.The research group believes that postoperative patients with colorectal adenoma have the pathogenic features of spleen failing to transport,phlegm obstruction causing qi stagnation,phlegm-damp accumulation in the stomach and intestine eventually developing into blood stasis.And then the phlegm,dampness and blood stasis interweaved in the intestinal tract and became latent toxin,which is prone to inducing the recurrence and tumor formation when triggered by pathogenic toxin.The therapeutic principle for postoperative recurrence of colorectal adenoma is to clear away the latent toxin by using medicines for strengthening the spleen and replenishing qi,assisting by medicines for regulating qi,resolving dampness,removing blood stasis,removing the toxin and eliminating tumors.And based on clinical practice,the basic recipe of Tiaochang Xiaoliu Prescription(mainly composed of Codonopsis Radix,Atractylodis Macrocephalae Rhizoma,Astragali Radix,Hedyotis Diffusae Herba,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle)is established,which may provide thoughts for clinical management of postoperative recurrence of colorectal adenoma.