结直肠癌合并糖尿病的围手术期处理

目的探讨结直肠癌合并糖尿病围手术期的处理原则。方法结合国内外文献，对外科治疗的42例合并2型糖尿病结直肠癌病例进行回顾性分析。结果42例患者均进行限期或急诊手术，术后并发症发生率：切口感染9．52％（4／42），泌尿系感染2.38%（1／42），吻合口瘘4．76%（2／42），无酮症酸中毒及死亡病例。结论良好的血糖控制，合适的术式选择，对于结直肠癌合并糖尿病患者安全渡过围手术期至关重要。     

大肠癌中医药临床研究进展

中医药在大肠癌诊治中占据重要地位,尤其是对联合化疗增效减毒、抗复发转移、治疗并发症、延长生存时间、改善生活质量等方面有显著疗效,为大肠癌的治疗提供了极为广阔的市场和社会价值。文章通过相关文献资料从基础、临床研究加以归纳综述。     

大肠癌中医药临床研究进展

中医药在大肠癌诊治中占据重要地位,尤其是对联合化疗增效减毒、抗复发转移、治疗并发症、延长生存时间、改善生活质量等方面有显著疗效,为大肠癌的治疗提供了极为广阔的市场和社会价值。文章通过相关文献资料从基础、临床研究加以归纳综述。     

Chinese Medicine for Outcomes in Colorectal Cancer Patients: A Retrospective Clinical Study

Objective: To investigate the effect of Chinese medicine(CM) on survival of patients with stage Ⅱ and Ⅲ colorectal cancer(CRC). Methods: A total of 295 patients who received chemotherapy were assigned to Group 1. The other 171 patients received the same chemotherapy treatment combined with the usage of CM Jianpi Jiedu Formula(健脾解毒方, JPJD) for more than 3 months(Group 2). Patients' survival time, relapse and metastasis, and cause of death were observed. Cox proportional hazard regression models were established for the analysis of the effect of independent factors on the survival prognosis of patients with CRC. Results: The survival rate of patients in Group 2 was higher than that of Group 1(P0.05). Compared with Group 1, the mean survival time was prolonged by 5.594 months and the median survival time was prolonged by 6 months in Group 2(P=0.004). Cox regression analysis indicated that CM combined with chemotherapy provided significant protective effect, as observed with the improvements in the survival rates of CRC patients(P0.01). Conclusion: CM can improve the survival rate in patients with stage Ⅱ and Ⅲ CRC.     

中医辨证施治配合化疗治疗晚期大肠癌30例

目的：观察中医辨证施治配合化疗治疗晚期大肠癌的疗效及毒副反应。方法：选择60例大肠癌患者,随机分成治疗组和对照组各30例,治疗组采用中医辨证施治配合化疗,对照组单用化疗。结果：有效率治疗组为30%,对照组为20%,两组无显著性差异（P〉0.05）。治疗组的血液毒副反应率明显低于对照组（P〈0.05）,生活质量提高率分别为60%和33.3%（P〈0.05）。结论：中医辨证施治配合化疗治疗晚期大肠癌,可减轻化疗的毒副反应,按期完成化疗,提高患者生活质量。     

中医药治疗大肠癌研究进展

大肠癌是发病率较高的恶性肿瘤之一,目前西医治疗以手术、放化疗为主。但由于复发与转移导致病人生存期及生存质量均不高。而各阶段配合以中医中药治疗,对延长病人生存期,提高病人生存质量,降低复发率与转移率等都具有明显优势。通过对近两年相关专著、期刊报道等文献资料从临床研究及实验研究两方面加以归纳综述。     

中医治疗慢性疲劳综合征的研究

目的对中医治疗慢性疲劳综合征进行探讨。方法运用中医综合疗法治疗72例慢性疲劳综合征，随机分成治疗组、对照组（各36例），治疗组采取中医综合疗法，对照组采用西药治疗，对中医治疗慢性疲劳综合征进行了疗效观察。结果治疗组：病愈22例，显效12例，无效2例，总有效率94．40％；对照组：病愈0例，显效6例，无效30例，总有效率16．66％。两组有极显著差异（P〈0．01）。结论中医治疗慢性疲劳综合征有着独特的优势，是一种治疗慢性疲劳综合征的有效方法，值得临床推广应用。     

Chinese Medicine Herbal Treatment Based on Syndrome Differentiation Improves the Overall Survival of Patients with Unresectable Hepatocellular Carcinoma

Objective:To investigate the effects of Chinese medicine(CM) herbal treatment based on syndrome differentiation on patients with unresectable hepatocellular carcinoma(HCC).Methods:A total of 94 patients with unresectable HCC were reviewed between June 2008 and June 2011.Survival analysis was performed between patients who received CM with/without non-curative antitumor treatments of Western medicine(WM)(CM group,30cases) and patients who were not treated with CM but with non-curative antitumor treatments of WM or supportive treatment alone(non-CM group,64 cases).Then,survival analysis was performed between patients treated with CM combined with non-curative antitumor treatments of WM(combination therapy group,25 cases) and patients with non-curative antitumor treatments of WM alone(non-curative antitumor treatments group of WM,52 cases).The survival analysis was performed by Kaplan-Meier method and prognostic factors for overall survival(OS) were assessed by the Cox proportional hazards regression model.Results:The median survival time(MST),1- and 2-year survival rates of the CM group and the non-CM group were 36 months,76.7%,56.1%and 12 months,48.4%,26.6%,respectively.The Log-rank test revealed significant difference between the two groups in OS(P<0.01).Cox proportional multivariate analysis revealed that CM was an independent favorable prognostic factor for OS.The MST,1- and 2-year survival rates of combination therapy group and non-curative antitumor treatments group of WM were 36 months,76.0%,55.5%and 13 months,55.8%,30.8%,respectively.There was significant difference in OS between the two groups(P=0.004).Conclusions:CM herbs based on syndrome differentiation have positive effects on survival of patients with unresectable HCC.Furthermore,combination therapy of CM and WM are recommended in HCC treatment.     

大肠癌围手术期中医证候动态变化规律临床研究

目的观察大肠癌围手术期患者中医证候分布及动态变化规律,为中医药干预提供证候学依据。方法对228例大肠癌手术患者进行临床调查,观察手术前后临床症状、舌象、中医辨证及证候变化。结果大肠癌患者术前以气血瘀滞证(34.2%)和湿热蕴结证(28.9%)两类实证为主;术后早期(术后1周)虚性证候明显增加,主要为气血两虚证(17.1%);术后中期(术后1个月)呈现虚实夹杂之象;术后晚期(术后3个月)虚证比例逐渐降低;结论大肠癌患者围手术期中医证候演变呈现一定规律,大肠癌围手术期的中医药治疗可遵循这一规律。     

围绝经期综合征的中医证治规律探讨

围绝经期妇女,肾气渐衰,阴液亏损,脏腑失衡。故治疗上提出以补肾为主,兼顾脏腑、阴阳之法,以防治围绝经期综合征。     

回结肠插管造瘘在大肠癌梗阻的围手术期应用

目的 :探讨围手术期造瘘在大肠癌梗阻治疗中的作用。方法 :1994年以来对 4 0例大肠癌合并肠梗阻的患者 ,采用围手术期造瘘结合手术治疗。经回肠末端插管穿过回盲部到升结肠 ,减压及引流 1周 ,后 3d行肠道准备。然后行根治性切除 ,术后继续保留造瘘管减压 1周。结果 :4 0例中 2例死于其他合并症或并存疾病 ,38例恢复顺利 ,无吻合口漏等严重并发症发生。结论 :围手术期管式造瘘应用于大肠癌合并梗阻的治疗 ,对预防吻合口漏等并发症有积极作用 ,管式造瘘简便易行 ,避免了常规结肠造口所致生活不便及日后关闭瘘口之痛苦     

中医辨证治疗140例中晚期大肠癌术后患者的临床分析

目的:探讨中医辨证治疗对中晚期大肠癌术后患者的疗效及预后的影响。方法:采用随机对照研究方法,选取ⅡB-ⅢC期大肠癌术后患者140例作为治疗组,以辨证汤药配合化疗治疗;同期选取ⅡB-ⅢC期大肠癌术后患者70例作为对照组,以单纯化疗治疗。比较两组患者的生存情况、复发转移情况及相关免疫指标、肿瘤指标的变化,同时将可能对大肠癌术后的预后产生影响的因素导入Cox风险比例模型进行多因素分析。结果:①治疗组的中位生存期为25.2个月,对照组为18.5个月;治疗组1年、3年生存率分别为87.86%、72.14%,对照组分别为85.71%、62.86%。治疗组复发转移率为22.86%,对照组为24.29%。其中,治疗组中位生存期明显长于对照组,且治疗组3年生存率显著高于对照组(P0.05),两组的复发转移率及复发转移出现时间未见显著性差异(P0.05)。②生存期Cox风险比例模型的多因素分析提示,疾病分期是影响预后的不利因素,中医治疗时间,中医治则中温补肾阳、补血养阴的用药原则是影响预后的有利因素;转移时间Cox风险比例模型的多因素分析提示,中医治疗时间、中医治则中理气的用药原则是影响转移的有利因素。③治疗后,治疗组CD4 T淋巴细胞的比例较治疗前明显上升,且治疗后治疗组CD4 T淋巴细胞的比例较对照组亦明显升高(P0.05)。结论:中医辨证治疗可以延长中晚期大肠癌术后患者的生存期,改善免疫状态,特别是温补肾阳、补血养阴的中医治则对患者预后具有一定的积极作用。     

中医药治疗晚期大肠癌研究进展

从生存期、生存率的角度,回顾中医药治疗晚期大肠癌的研究进展,并对其研究现状作简要分析。     

围绝经期综合征的中医证治规律探讨

围绝经期妇女,肾气渐衰,阴液亏损,脏腑失衡。故治疗上提出以补肾为主,兼顾脏腑、阴阳之法,以防治围绝经期综合征。     

中医药联合化疗治疗晚期结直肠癌近期疗效和生存质量的Meta分析

目的比较中医药联合化疗与单纯化疗治疗晚期结直肠癌在近期疗效和生存质量方面的差异。方法应用Meta分析方法的随机效应模型,对国内2000年1月-2012年6月为止单纯采用中医药联合化疗治疗晚期结直肠癌,并以单纯化疗作对照的研究文献进行定量合并分析。结果在肿瘤患者缓解率方面,中医药联合化疗组的418例患者中有159例取得了完全或部分缓解,化疗组363例患者中有107例取得了完全或部分缓解,2组比较,P0.01。中医药联合化疗组的147例患者中有89例生存时间超过1a,化疗组102例患者中有47例生存时间超过1a,2组比较,P0.01。在生存质量方面,中医药联合化疗组的267例患者中有155例卡氏评分提高,化疗组243例患者中有76例患者卡氏评分提高,2组比较,P0.01。结论中医药联合化疗方案在治疗晚期结直肠癌患者有效率和1年生存率上优于单纯化疗方案,而且中医药联合化疗在提高生存质量上有明显优势。     

结直肠癌淋巴结转移的多因素回归分析

目的探讨结直肠癌淋巴结转移规律及其影响因素，为临床诊断、治疗和预后评估提供参考。方法分类整理武汉大学中南医院1990年1月-2006年12月手术治疗的1127例结直肠癌病人的病历资料，采用χ^2检验及Logistic多因素回归分析方法，研究淋巴结转移与临床病理参数之间的相关性。结果单因素分析显示，患者的性别、肿瘤部位与淋巴结转移无明显相关性。影响淋巴结转移的因素有患者的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、病理组织学类型和分化程度。40岁以下的结直肠癌患者淋巴结转移率明显高于40岁以上者（P〈0．01）；淋巴结转移率随肿瘤直径的增大而增加（P〈0．001）；肿瘤浸润肠壁的深度增加，淋巴结转移率增加（P〈0．001）；肿瘤的分化程度越低，淋巴结转移率越高（P〈0．001）。Logistic回归分析显示，结直肠癌淋巴结转移与病人的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、肿瘤的分化程度相关，影响淋巴结转移的相关因素由强到弱依次为肿瘤浸润肠壁的深度、肿瘤的分化程度，在所选因素中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。结论结直肠癌淋巴结转移与病人的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、病理组织学类型及分化程度相关，其中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。     

Preliminary Research on Syndrome Types of Chinese Medicine in Children with Primary Nephrotic Syndrome

Objective

To provide an objective reference for the syndrome types of Chinese medicine (CM) associated with pediatric primary nephrotic syndrome (PNS).

Methods

A cross-sectional study was performed. Data on clinical symptoms, CM syndrome types, biochemical indices, and medications used were collected from 98 children with PNS. Then, the correlation between CM syndromes and biochemical indices, as well as medications used, was analyzed.

Results

The four most common symptoms in children with PNS were brown urine, red tongue, excessive sweating, and swelling of the face and limbs. The syndromes of qi deficiency of Fei (Lung) and Shen (Kidney) (FSQD) and yin deficiency of Gan (Liver) and Shen (GSYD) were the most common main CM syndrome types. FSQD syndrome score correlated significantly with the total cholesterol level, urine protein/creatinine ratio, and urine IgG and albumin levels (P<0.01 or P<0.05). The use of maintenance glucocorticoids combined with immunosuppressive agents correlated with FSQD syndrome, and the use of maintenance glucocorticoids alone correlated with GSYD syndrome (P<0.05).

Conclusion

Two of the most common CM syndrome types were FSQD and GSYD syndromes. FSQD syndrome may be caused by some factors related to lipid levels, protein loss, and the use of immunosuppressive agents. The use of maintenance glucocorticoids may cause GSYD syndrome

     

中医临床案例证素辨识一致性研究

目的:评价中医临床案例证素辨识的一致性及证素辅助诊断参考在临床案例证素辨识中的作用。方法:从规范四诊信息的中医大型临床案例数据库中随机抽取50个案例,采用两轮德尔菲专家咨询法,针对每一个案例邀请4位专家做出证素辨识,两轮咨询间隔一周以上。第一轮仅给予50个临床案例的四诊资料,请专家逐一作出证素辨识;第二轮在给予证素辅助诊断参考的前提下,请相同4位专家对上述50个临床案例再次做出证素辨识。两轮证素辨识一致性均采用肯德尔和谐系数进行评价。结果:第一轮专家证素辨识涉及37个证素,其中23个证素(占62%)通过一致性评价;第二轮专家证素辨识涉及29个证素,其中19个证素(占66%)通过一致性评价;两轮专家咨询各证素辨识一致性之间的差异没有统计学意义。结论:多位中医专家对同一临床案例的证素辨识存在一定的不一致性,而给予专家证素辅助诊断参考,对专家做出一致的证素辨识不一定具有促进作用。     

痹证之中医特色疗法中药蜡疗简

中医特色医疗技术在痹证的治疗方面有很大优势,在减少药物的用量、减少药物的毒副作用、增强内服药物的疗效方面起到很好的作用。我院康复中心在古法蜡疗基础上,独创中药蜡疗应用于多种疾病,其中风湿类风湿性关节炎、关节僵硬疗效显著。     

中医辨证论治心脏X综合征

心脏X综合征有心绞痛的表现,但其预后与冠脉狭窄引起的心绞痛迥然不同。由于现代医学对此病的认识有限,在治疗方面疗效并不理想,而运用中医药在治疗心脏X综合征方面有很突出的特色和优势,经临床验证疗效满意。