[1]王鑫 杜娟杨洋.加味大柴胡汤联合化疗治疗晚期胆道肿瘤压迫引起的梗阻性黄疸的疗效观察[J].现代中医药,2020,(03):083-87.[doi:10.13424/j.cnki.mtcm.2020.03.023]
　Wang Xin,Du Juan,Yang Yang.An Observation of Curative Effect of Treating Obstructive Jaundice Caused by Advanced Biliary Tract Tumor Compression by Dachaihu Decoction Combining with Chemotherapy[J].Modern Traditional Chinese Medicine,2020,(03):083-87.[doi:10.13424/j.cnki.mtcm.2020.03.023]
点击复制

加味大柴胡汤联合化疗治疗晚期胆道肿瘤压迫引起的梗阻性黄疸的疗效观察()
分享到：

《现代中医药》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2020年03期
页码:
083-87
栏目:
出版日期:
2020-05-10

文章信息/Info

Title:
An Observation of Curative Effect of Treating Obstructive Jaundice Caused by Advanced Biliary Tract Tumor Compression by Dachaihu Decoction Combining with Chemotherapy
文章编号:
1672-0571(2020)03-0083-05
作者:
王鑫1 杜娟1杨洋2
1.陕西中医药大学附属医院肝胆外科,陕西 咸阳 712000;
2.西安国际医学中心,陕西 西安 710000
Author(s):
Wang Xin 1;  Du Juan;  Yang Yang 2
1. Department of Hepatobiliary Surgery in Hospital Affiliated to Shaanxi University of Chinese Medicine ,Xianyang Shaanxi 712000
2. Xi’an International Medical Center Hospital, Xi’an Shaanxi 710000
关键词:
大柴胡汤加味; 胆道恶性肿瘤; 梗阻性黄疸; 疗效观察; 肝功能损害; 胆红素升高
Keywords:
Dachaihu Decoction;  biliary malignant tumor;  obstructive jaundice;  clinical curative effect observation;  impair liver function;  Elevated bilirubin
分类号:
R575
DOI:
10.13424/j.cnki.mtcm.2020.03.023
文献标志码:
A
摘要:
目的 探讨加味大柴胡汤联合化疗对晚期胆道肿瘤持续性黄疸干预的疗效观察?方法 纳入 2016年10月 ~2018年 5月在本科接受 PTCD术的 60例晚期胆道肿瘤梗阻性黄疸患者,随机分为观察组 30例,采用吉西他滨单药,1000mg/m2,静滴,21天一周期;治疗组 30例,在对照组基础上联合加味大柴胡汤治疗?治疗 2周期后,以两组患者的总体有效控制率(DCR)及客观缓解率(ORR)为主要指标,次要指标观察两组患者的毒副反应,治疗前?治疗 1周期及 2周期后患者 AST?ALT?TBIL及 DBIL的变化?结果 治疗组与对照组在疾病客观缓解率(0RR)比较为 33.3% VS20%,无统计学差异(X2 =1.364,P=0.243);其疾病总体有效率(DCR)比较为83.3% VS60%,具有统计学差异(X2=4.022,P=0.045);两组治疗过程中治疗组主要的毒性反应为恶心呕吐?腹泻?腹痛及骨髓抑制?两组恶心呕吐的发生率治疗组优于对照组 10例(33.3%)VS19例(63.3%),比较具有统计学差异(P=0.020);治疗组腹泻的发生率明显低于对照组,分别为 3例(10%)VS对照组 12例(40%),比较具有显著性统计学差异(P=0.007);而在患者腹痛及骨髓抑制等方面,两组患者的发生率比较无明显差别,比较无统计学意义(P>0.05),尚未在治疗过程中出现Ⅳ度毒性反应及药物相关不良事件;治疗组治疗 1周期及 2周期后 ALT?AST?TBIL及 DBIL数值较对照组数值具有统计学意义,(P<0.05)?结论 加味大柴胡汤联合化疗对胆道肿瘤压迫引起的梗阻性黄疸具有提高疾病总体有效率,减轻化疗后毒副反应和改善肝脏功能的作用,值得临床进一步推广和应用?
Abstract:
Objective To observe the curative effect of intervening persistent jaundice caused by Advanced Biliary Tract Tumor Compression by Dachaihu Decoction combining with chemotherapy. Method 60 cases who received PTCD ranging from October 2016 to May 2018 in Department of Hepatobiliary surgery are selected and randomly divided into the observation group of 30 cases. They are given the intravenous drip of gemcitabine monotherapy, 1000mg/ m 2 , for a cycle of21 days. Another 30 cases in the treatment group are given the Dachaihu Decoction plus the medicine in the former group. After 2 cycles of treatment, the DCR and ORR in two groups are the primary indexes , secondary to which include the toxic and adverse effect, the variation in AST, ALT, TBIL and DBIL before the treatment, for a cycle and two cycles. Result The ratio of ORR between two groups is 33. 3% vs. 20% with no statistical significance( x 2 =1. 364, p =0. 243) .The ratio of DCR is 83. 3% vs. 60% with statistical significance( x 2 =4. 022, p =0. 045) . The primary toxic and adverse effects include nausea and vomiting, diarrhea, abdominal pain and myelosuppression. The occurrence rate of 10 cases in treatment group in terms of nausea and vomiting is superior to the 19 cases in control group( 33. 3vs. 63. 3) with statistical significance( p =0. 020) . The occurrence of diarrhea of 3 cases in treatment group is slightly lower than 12 cases of the control group ( 10%vs. 40%) with relatively statistical significance( p =0. 007) . However, the occurrence rate in terms of abdominal pain and myelosuppression is relatively no statistical significance since the difference is not obvious( p>0. 05) . No toxic effect and adverse event of level Ⅳ associated with medicine occur. The data of AST, ALT, TBIL and DBIL in treatment group after one cycle and 2 cycles is of statistical significance by contrast with control group( p < 0.05) . Conclusion Dachaihu Decoction can improve the DCR of treating Jaundice Caused by Advanced Biliary Tract Tumor Compression by Dachaihu Decoction combining with chemotherapy, and alleviate the toxic and adverse effects after chemotherapy, improving the hepatic function, thereby it is worth being widely promoted and applied.

参考文献/References:

[1] Monson JR, Donohue JH, McEntee GP, et al. Radical resection for carcinoma of the ampulla of Vater[ J] . Arch Surg,1991,126:353 -357.
[2] Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors[ J] . Ann Surg,1996,224:463 -473.
[3] Regimbeau JM, Fuks D, Bachellier P, et al. Prognostic value of jaundice in patients with gallbladder cancer by the AFC - GBC - 2009 study group[ J] . Eur J Surg Oncol, 2011,37:505 -512.
[4] National Comprehensive Cancer Network ( NCCN) guidelines. Available at: < www. nccn. org > [ accessed 04.11. 14] .
[5] Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer[ J] . N Engl J Med,2010,362:1273 -281.
[6]中国抗癌协会.胆囊癌规范化诊治专家共识(2016)[J].临床肝胆病杂志 2017,33(4):611-620.
[7]黄忠华,石炳林,何传果,等.恶性梗阻性黄疸治疗进展[J].中国医学创新,2019,16(14):169-172.
[8]刘立业,仝林虎.胆囊癌诊断的研究进展[J].内蒙古医学杂志,2017,49(6):675-679.
[9]迟洪亮.干扰素辅助化疗方案在治疗胆囊癌中的作用[J].实用癌症杂志 2015,12(6):874-876.
[10]皋文君,刘砚燕,袁长蓉.国际肿瘤化疗药物不良反应评价系统———通用不良反应术语标准 4.0版[J].肿瘤,2012,32(2):142-144.
[11]张小坚,张联合,张士良,等.经内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的比较[J].中华全科医学,2016,14(4):575-577.
[12]吴璐璐,袁昌劲,刘娇萍.复方苦参注射液联合 PTCD 胆道支架置入术治疗恶性梗阻性黄疸的临床观察[J].辽宁中医杂志,2018,5(45):1007-1009.
[13]何立春,席多宏,李兴禹,等.茵陈五苓散治疗梗阻性黄疸术后 30例[J].现代中药,2018,2(38):43-44.
[14]王宗柱.浅析大柴胡汤证[J].现代中医药,2004,24(6):1-2.
[15]吴彦超.加味大柴胡汤治疗急性胆囊炎肝胆湿热型 40例[J].陕西中医学院学报,2011,34(4):44-45.

备注/Memo

备注/Memo:
通讯作者:杜娟,主管护师?E-mail:2923797369@qq.com
更新日期/Last Update: 2020-05-22