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癌毒病机理论指导下消癌汤联合腹腔镜辅助远端胃切除术治疗老年胃癌的临床研究
作者:刘伟  朱帅  杜江  李华 
单位:延安市人民医院普外科  陕西 延安 716000 西安交通大学医学院第二附属医院普外科  陕西 西安 710004 
关键词:胃肿瘤/外科学 腹腔镜检查/方法 中医病机 抗肿瘤药(中药)/治疗应用 胃肿瘤/中药疗法 汤剂 综合疗法 老年人 
DOI:R735.2;R730.56
出版年,卷(期):页码:2018,33(3):222-227
摘要:

目的 探讨基于癌毒病机理论的指导下的消癌汤联合腹腔镜辅助远端胃切除术治疗老年胃癌的临床疗效。方法 选取98例老年胃癌患者作为研究对象,采用随机数字表法将其分为观察组与对照组,每组49例。对照组患者行腹腔镜辅助远端胃切除术治疗,而观察组则在对照组基础上另给予消癌汤,2组患者治疗时间均为3个月。治疗后,评价2组治疗效果。治疗前、后,分别对2组患者胃痛、胃胀、反酸、进食梗阻及恶心/呕吐等中医证候评分进行观察,检测患者IgA、IgG、IgM、CD3+及CD4+等免疫指标含量。治疗后,对2组患者进行为期2年的随访,观察治疗后1年与2年生存率,并统计患者无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)。结果 观察组总有效率为89.8%,对照组为75.5%,差异具有统计学意义(P<0.05)。治疗后,观察组胃痛、胃胀、反酸、进食梗阻及恶心/呕吐等中医证候评分均低于对照组(均P<0.05)。治疗后,观察组IgA[(17.45±1.98) g/L vs(8.15±1.45) g/L]、IgG[(3.19±0.46) g/L vs(1.15±0.18) g/L]、IgM[(3.27±0.49) g/L vs(1.19±0.19) g/L]、CD3+[(48.25±4.15)%vs(40.52±3.71)%]及CD4+[(39.73±3.24)%vs(30.75±3.49)%]水平均高于对照组(均P<0.05)。观察组1年生存率[87.2%vs 76.1%]、2年生存率[70.2%vs 52.1%]、PFS[(20.98±2.38)个月vs(18.71±1.92)个月]及OS[(18.41±1.62)个月vs(16.51±1.43)个月]均高于对照组(均P<0.05)。结论 基于癌毒病机理论指导下消癌汤联合腹腔镜辅助远端胃切除术治疗老年胃癌疗效确切,可有效改善患者症状,提高患者免疫力。

Objective To observe the effects of Xiaoaitang based on the pathogenesis theory of cancerous toxin combined with laparoscopic assisted distal gastrectomy in the treatment of elderly patients with gastric cancer.Methods Ninety-eight cases of elderly patients with gastric cancer were enrolled and randomly assigned into the observation group and the control group, with 49 cases in each group. Both groups were treated with laparoscopic assisted distal gastrectomy therapy, whereas the observation group received Xiaoaitang additionally. The treating process lasted for 3 months for all patients. After the treatment, the effects were analyzed for the two groups. Chinese medicine symptom complex scores, such as abdominal pain, bloating, anti-acid, eating obstruction and vomiting/nausea, were evaluated before and after the treatment. The immune function indices, including IgA, IgG, IgM, CD3+ and CD4+, were also tested. Moreover, all patients were followed-up for 2 years after the treatment. Progression-free survival (PFS) and overall survival (OS) were observed and one-year and two-year survival rates were calculated.Results After the treatment, the overall response rate was 89.8% in the observation group, and 75.5% in the control group (P<0.05). The levels of Chinese medicine symptom complex scores including abdominal pain, abdominal bloating, anti-acid, eating obstruction and vomiting/nausea scores were significantly lower in the observation group than those in the control group (all P<0.05). Besides, multiple immune function indices were also significantly decreased in the observation group compared with the control group[IgA:(17.45±1.98) g/L vs (8.15±1.45) g/L; IgG:(3.19±0.46) g/L vs (1.15±0.18) g/L; IgM:(3.27±0.49) g/L vs (1.19±0.19) g/L; CD3+:(48.25±4.15)% vs (40.52±3.71)%; CD4+:(39.73±3.24)% vs (30.75±3.49)%); all P<0.05]. Finally, one-year survival rate (87.2% vs 76.1%), two-year survival rate (70.2% vs 52.1%), PFS[(20.98±2.38) months vs (18.71±1.92) months] and OS[(18.41±1.62) months vs (16.51±1.43) months] were also significantly higher in the observe group than those in the control group (all P<0.05).Conclusion Xiaoaitang based on pathogenesis theory of cancerous toxin combined with laparoscopic assisted distal gastrectomy has good clinical effects in the treatment of elder patients with gastric cancer, which significantly alleviates clinical symptoms and enhances the immune function.

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