归夏散结汤预防结直肠腺瘤术后复发的临床研究

Efficacy of Guixia Sanjie Decoction on postoperative recurrence of colorectal adenoma

目的观察归夏散结汤预防结直肠腺瘤术后复发的临床疗效。方法选取2022年1—7月河北省中医院收治的90例行结直肠腺瘤内镜下切除术的患者作为研究对象,采用随机数字表法将入选者分为治疗组和对照组,每组45例。2组均于术后对患者进行健康教育,指导患者规律作息、合理饮食(减少红肉摄入)、调畅情志,治疗组加服归夏散结汤治疗12周。比较2组患者术后治疗前、治疗12周临床症状评分及血清白细胞介素-6(IL-6)、前列腺素E_(2)(PGE_(2))、肿瘤坏死因子-α(TNF-α)水平,评估2组治疗12周后临床疗效,并记录治疗期间不良反应发生情况;于术后1年复查肠镜,统计腺瘤复发情况以及腺瘤数量与大小。结果治疗12周后,对照组仅黏液血便、腹胀、里急后重评分较治疗前明显降低(P均<0.05),治疗组腹痛、腹胀、黏液血便、便秘、里急后重、腹泻评分均明显低于治疗前及对照组(P均<0.05);2组血清IL-6、PGE_(2)、TNF-α水平均较治疗前明显降低(P均<0.05),且治疗组IL-6、PGE_(2)、TNF-α水平均明显低于对照组(P均<0.05);治疗组总有效率明显高于对照组[80.0%(36/45)比57.8%(26/45),P<0.05]。2组患者在治疗期间未见严重不良反应。术后1年复查肠镜,治疗组腺瘤复发率明显低于对照组[20%(9/45)比40%(18/45),P<0.05],且治疗组腺瘤数量及最大直径均明显低于对照组(P均<0.05)。结论归夏散结汤能明显改善结直肠腺瘤术后患者症状,减轻机体炎症反应,有效预防结直肠腺瘤术后复发,且安全性好。

Objective It is to observe the clinical effect of Guixia Sanjie Decoction in preventing postoperative recurrence of colorectal adenoma.Methods Ninety patients undergoing endoscopic resection of colorectal adenoma in Hebei Provincial Hospital of Traditional Chinese Medicine from January to July 2022 were selected as the study objects and divided into treatment group and control group according to random number table method,with 45 cases in each group.The patients of the two groups were given health education after surgery,they were instructed to work and rest regularly,eat reasonably(reduce red meat intake),and regulate mood.Additionally,the treatment group was treated with Guixia Sanjie Decoction for 12 weeks.The clinical symptom scores and serum levels of interleukin-6(IL-6),prostaglandin E_(2)(PGE_(2))and tumor necrosis factor-α(TNF-α)of the patients in the two groups before and after 12 weeks of treatment were compared,the clinical efficacies of the two groups after 12 weeks of treatment were assessed,and the occurrences of adverse reactions during the treatment period were recorded.The colonoscopy was reexamined in 1 year after surgery to calculate the recurrence of adenomas as well as the number and size of adenomas.Results After 12 weeks of treatment,only the symptom scores of mucous blood stools,abdominal distension,tenesmus and diarrhea were significantly decreased compared with before treatment in the control group(all P<0.05),the symptom scores of abdominal pain,abdominal distension,mucous blood stools,constipation,tenesmus and diarrhea in the treatment group were all significantly lower than those before treatment and in the treatment group(all P<0.05).After 12 weeks of treatment,the serum levels of IL-6,PGE_(2)and TNF-αwere significantly lower than those before treatment in the two groups(all P<0.05),and the serum levels of IL-6,PGE_(2)and TNF-αin the treatment group were significantly lower than those in the control group(all P<0.05);the total effective rate of the treatment group was significantly higher than that of the control group[80.0%(36/45)VS.57.8%(26/45),P<0.05].No serious adverse reactions were observed in the two groups during the treatment period.The results of colonoscopy in one year after surgery showed that the recurrence rate of adenomas in the treatment group was significantly lower than that in the control group[20%(9/45)VS.40%(18/45),P<0.05],and the number and maximum diameter of adenomas in the treatment group were significantly lower than those in the control group(both P<0.05).Conclusion Guixia Sanjie Decoction can effectively improve the symptoms of patients with colorectal adenocarcinoma after surgery,alleviate their body inflammatory response,and effectively prevent the recurrence of colorectal adenoma after surgery with good safety.