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。
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 levelⅣassociated 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.
作者
王鑫
杜娟
杨洋
Wang Xin;Du Juan;Yang Yang(Department of Hepatobiliary Surgery in Hospital Affiliated to Shaanxi University of Chinese Medicine,Xianyang Shaanxi 712000;Xi’an International Medical Center Hospital,Xi’an Shaanxi 710000)
出处
《现代中医药》
CAS
2020年第3期83-87,共5页
Modern Chinese Medicine
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
Dachaihu Decoction
biliary malignant tumor
obstructive jaundice
clinical curative effect observation
impair liver function
Elevated bilirubin
