原发性肺癌化疗后吞咽困难案一则

Treating one case of dysphagia from primary lung cancer after chemotherapy

原发性肺癌是我国常见恶性肿瘤之一,近年来其发病率和病死率均居全国首位。根据临床特征,可将该病大致分为小细胞肺癌和非小细胞肺癌两类。临床中,小细胞肺癌的发病率较低,占原发性肺癌患者的15%~20%,由于其具有一定的生物学特异性,故多采用以放疗联合化疗为主的综合治疗方案。非小细胞肺癌的发病率较高,占原发性肺癌患者总数的80%~85%,临床上常见的亚型有腺癌、鳞癌等。在延长患者生存时间方面,放射治疗、外科手术、分子靶向治疗等都是十分有效的治疗手段。化疗是一种常见的治疗手段,临床应用十分广泛,但是化疗药物不仅对肿瘤细胞造成损害,而且对正常细胞造成不良影响。经过反复放化疗,很多患者后期可能出现恶病质、恶心呕吐等躯体症状以及一系列心理问题,严重影响了患者的生活质量,降低了患者的存活率。本病案中患者吞咽障碍是原发性肺癌化疗术引起的消化道不良反应,属于中医“噎膈”范畴。杨兆钢主任传承著名中医师沈金山的芒针奇术,擅长运用针灸,亦擅长运用中药,采用理气开郁散结、滋阴养血解毒的治疗大法,运用芒针联合中药治疗该病,取得较好的疗效。笔者有幸跟师临诊,现将本案详细诊疗经过整理分享如下,以促进同行交流,为临床治疗该病提供更优的解决方案。

Primary lung cancer is one of the most common malignant tumors in China.In recent years,its morbidity and mortality have both taken the first place in China.According to its clinical characteristics,the disease can be roughly divided into two categories,small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC).In clinical practice,the incidence of SCLC is relatively low,accounting for 15%-20%of patients with primary lung cancer.Due to its biological specificity,the treatment method is mainly radiotherapy combined with chemotherapy.The incidence of NSCLC is relatively high,accounting for 80%-85%of the total number of primary lung cancer patients,and its common clinical subtypes in clinical practice include adenocarcinoma,squamous cell carcinoma,etc..In terms of prolonging the survival time of patients,radiotherapy,surgery,molecular targeted therapy and so on are very effective treatment methods.Chemotherapy is a common treatment means,its clinical application is very wide,but chemotherapy drugs not only damage tumor cells,but also cause adverse effects on normal cells.Due to repeated chemoradiotherapy,many patients may have physical symptoms such as cachexia,nausea and vomiting,as well as a serious of psychological problems in the later stage,which seriously affects the quality of life of patients and reduces their survival.In this article,swallowing disorder is an adverse reaction of the digestive tract caused by chemotherapy for primary lung cancer,and belongs to the category of choking diaphragm in TCM.Director YANG Zhaogang inherits the wonderful technique of elongated needle from SHEN Jinshan,a famous TCM physician,and is skilled in the application of acupuncture and TCM medicines.The treatment method of regulating Qi(气),dissipating stagnation,dispersing accumulation,nourishing Yin(阴)and blood,and detoxifying is adopted by the director,and elongated needle plus TCM medicine are used to treat this disease,with good curative effects.The author has the honor to learn from Director YANG Zhaogang.Now,the detailed diagnosis and treatment of one empirical case is sorted out and shared as follows in order to promote interaction and provide better solutions for clinical treatment of the disease.