單純內(nèi)鏡下手術(shù)聯(lián)合清中湯加減治療胃腸道間質(zhì)瘤的效果分析

周磊　韓樹堂

[摘要] 目的 探討單純內(nèi)鏡下手術(shù)聯(lián)合清中湯加減治療胃腸道間質(zhì)瘤的臨床療效。 方法 從2017年1月～2019年1月我院收治胃腸道間質(zhì)瘤患者中擇取100例中醫(yī)證型為濕熱內(nèi)阻證的患者，隨機(jī)分為試驗(yàn)組（單純內(nèi)鏡下手術(shù)聯(lián)合清中湯加減治療）和對照組（單純內(nèi)鏡下手術(shù)），每組50例。比較觀察兩組治療后中醫(yī)癥狀改善情況，評價療效與安全性。 結(jié)果 試驗(yàn)組治療8周后中醫(yī)證候積分（13.72±3.16）分，低于對照組的（28.54±4.93）分，治療總有效率（96.0%）高于對照組（84.0%），差異有統(tǒng)計(jì)學(xué)意義（t=4.717，P=0.037;χ2=4.375，P=0.039），患者用藥期間出現(xiàn)2例惡心嘔吐，均為輕度癥狀，發(fā)生率4.0%，后經(jīng)指導(dǎo)有效克服。 結(jié)論 單純內(nèi)鏡下手術(shù)聯(lián)合清中湯加減治療濕熱內(nèi)阻證胃腸道間質(zhì)瘤效果確切，可加速改善患者胃腸道癥狀，促進(jìn)康復(fù)，應(yīng)用安全有效，值得臨床推廣。

[關(guān)鍵詞] 胃腸道間質(zhì)瘤;內(nèi)鏡下手術(shù);清中湯;辨證治療

[中圖分類號] R735? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2020）03-0102-03

[Abstract] Objective To investigate the clinical efficacy of endoscopic surgery combined with Qingzhong decoction in the treatment of gastrointestinal stromal tumors. Methods 100 patients with TCM syndromes as shire neizu syndrome were selected from patients with gastrointestinal stromal tumors in our hospital from January 2017 to January 2019. They were randomly divided into the experimental group（single endoscopic surgery combined with Qingzhong decoction） and the control group， with 50 cases in each group. The improvement of TCM symptoms， the efficacy and safety between the two groups after treatment were compared and evaluated. Results The TCM syndrome scores of the experimental group after 8 weeks of treatment （13.72±3.16） were lower than those of the control group （28.54±4.93）. The total effective rate of treatment （96.0%） was higher than that of the control group （84.0%）， with significant difference （t=4.717， P=0.037; χ2=4.375， P=0.039）. There were 2 cases of nausea and vomiting during the patient's medication， and both were mild symptoms. The incidence rate was 4.0%. After the guidance， they effectively overcame the nausea and vomiting. Conclusion Endoscopic surgery combined with Qingzhong decoction for the treatment of gastrointestinal stromal tumors with shire neizu syndrome is effective. It can accelerate the improvement of gastrointestinal symptoms and promote rehabilitation. It is safe and effective and worthy of clinical promotion.

[Key words] Gastrointestinal stromal tumor; Endoscopic surgery; Qingzhong decoction; Syndrome differentiation treatment

胃腸道間質(zhì)瘤（Gastrointestinal stromal tumor，GIST）是一組原發(fā)于胃腸道梭形細(xì)胞與上皮細(xì)胞的間葉源性腫瘤，具有潛在惡性傾向[1]。數(shù)據(jù)統(tǒng)計(jì)年發(fā)病率為（1～2）/10萬，集中見于40歲以上中老年人群，占全部胃腸道惡性腫瘤的1%～3%[2]。本病約60%發(fā)生于胃部，30%發(fā)生于小腸，少數(shù)見于結(jié)直腸、食管、大網(wǎng)膜、腸系膜、腹膜后腔等處，可引起惡心嘔吐、腹痛、胃腸道出血等并發(fā)癥，嚴(yán)重影響患者的生存質(zhì)量[3]。手術(shù)是臨床治療GIST首選方法，主要采用局部切除或楔形切除，近年隨著內(nèi)鏡技術(shù)的使用及推廣，鏡下GIST手術(shù)逐漸增多，雖為微創(chuàng)操作，但手術(shù)仍會對患者胃腸造成干擾，導(dǎo)致胃腸功能紊亂，影響術(shù)后生活質(zhì)量[4]。……