405例结肠癌患者围手术期的中医证型分布特征研究

Study on Distribution Characteristics of TCM Syndromes of 405 Patients with Colon Cancer in Perioperative Period

目的:研究结肠癌患者围手术期中医证型的分布特点,分析结肠癌患者围手术期中医证型分类的意义,为结肠癌患者围手术期-手术后中医药干预的客观合理性提供依据。方法:选取2019年3月至2020年9月在哈尔滨医科大学附属第一医院结直肠外科行腹腔镜结肠癌根治术患者405例作为研究对象,总结围手术期结肠癌患者中医证型的分布特征,并分析证型与临床分期、肿瘤部位、病理类型、分化程度的相关性。结果:围手术期结肠癌患者临床分期与不同中医证型差异有统计学意义(P<0.05),术前Ⅰ期、Ⅱ期以实证和虚实夹杂为主,湿热蕴结最多,脾虚湿盛次之;而Ⅲ期、Ⅳ期以虚证为主,依次为气血亏虚、肝肾阴虚、脾肾阳虚。术后Ⅰ期和Ⅱ期以脾虚湿盛最多,其次为湿热蕴结;Ⅲ期和Ⅳ期以虚证为主,以气血双亏分布最多,其次为肝肾阴虚、脾肾阳虚。不同中医证型与肿瘤部位、病理类型、分化程度无相关性,差异无统计学意义(P>0.05)。结论:结肠癌围手术期证候演变具有术前到术后由实证到逐渐变为虚证,由术前的湿、热等标实之证变为术后的脾肾阳虚、气血两虚证。手术前中医证型的分布与临床分期密切相关,术后中医证型变化与机体应激状态关联性更为密切。

Objective:This study aims to study the distribution characteristics of TCM syndromes of patients with colon cancer in the perioperative period,analyze the significance of TCM syndrome classification of patients with colon cancer patients in the perioperative period,and provide a basis for the objective rationality of Chinese medicine intervention in patients with colon cancer in perioperative and postoperative periods.Methods:A total of patients with laparoscopic radical resection of colon cancer in the Department of Colorectal Surgery of the First Affiliated Hospital of Harbin Medical University from March 2019 to September 2020 were recruited,and the distribution characteristics of TCM syndromes of patients with colon cancer in the perioperative period were summarized.The correlation among syndrome,tumor location,pathological type,differentiation degree,and clinical stage was analyzed.Results:There were significant differences between clinical stages and different TCM syndromes of patients with colon cancer in the perioperative period(P<0.05).In the early and middle stages(ⅠandⅡstages),the syndromes of excess and deficiency were the main type,and the accumulation of damp-heat was the most.In the middle and late stages(ⅢandⅣstages),the syndrome of deficiency was the main type,which was manifested by deficiency of qi and blood,deficiency of liver-yin and kidney-yin,and deficiency of spleen-yang and kidney-yang in turn.In the early postoperative period(ⅠandⅡstages),spleen deficiency with excessive dampness was the most common,followed by damp-heat accumulation.In the middle and late stages(ⅢandⅣstages),deficiency syndrome was the main type,and deficiency of both qi and blood was the most,followed by deficiency of liver-yin and kidney-yin and deficiency of spleen-yang and kidney-yang.There was no correlation between different TCM syndromes and tumor location,pathological type,and differentiation degree,with no statistical significance(P>0.05).Conclusion:During the perioperative period of colon cancer,the syndromes changed from preoperative excess syndrome to postoperative deficiency syndrome and from preoperative syndromes such as dampness and heat to postoperative syndromes such as deficiency of spleen-yang and kidney-yang and Qi-blood deficiency.The distribution of preoperative TCM syndromes is closely related to the clinical stage.Postoperative TCM syndrome changes are more closely related to the stress state of the body.