王振常运用柔肝化纤颗粒加减辨治肝癌切除术后腹水验案浅析  

Professor WANG Zhenchang’s experience in treating ascites after liver cancer resection with the Rougan Huaxian granules

作　　者：王静[1] 李亚楠[1] 劳慧霞 李菲 王振常[2] WANG Jing

机构地区：[1]广西中医药大学,广西南宁530000 [2]广西中医药大学附属国际壮医医院,广西南宁530000

出　　处：《中医临床研究》2024年第5期73-76,共4页Clinical Journal Of Chinese Medicine

基　　金：国家自然科学基金(81660745,81960910);广西自然科学基金(2020GXNSFDA297021)。

摘　　要：原发性肝癌恶性程度高,转移及浸润性强,早期结合血清生化标志物、影像学和病理检查可做出诊断,临床治疗上主要有手术切除、肝移植术、局部消融治疗、肝动脉化疗栓塞术治疗、放射治疗、分子靶向治疗、系统化疗、免疫治疗、中药治疗等手段,其中肝脏储备功能良好型Ia期、Ib期和IIa期肝癌首选手术切除。由肝静脉癌栓及肝癌浸润腹膜形成的腹水可为肝癌切除术后主要体征,且肝癌切除术后腹水发病率较高,具有复发性,西医治疗方案主要有限盐、利尿、穿刺大量放腹水及联合补充白蛋白等。而从中医病因病机上认为其源于肝病日久,肝、脾、肾三脏功能失调,血瘀、气滞、水停等病理因素结于腹中所致腹部胀大如鼓的一类病证,中医治则为攻补兼施,治法为活血化瘀、疏肝理气、利尿逐饮、扶正固本。本病预后较差,属于中医“臌”之顽证。文章通过对王振常教授运用柔肝化纤颗粒加减辨治肝癌切除术后腹水验案一则进行分析,浅谈王振常教授治疗肝癌切除术后腹水的思路和方法,以期为临床治疗肝癌切除术后腹水提供思路。Primary liver cancer has a high malignant degree,strong metastasis and invasion,and can be diagnosed early by combining serum biochemical markers,imaging and pathological examination.Its clinical treatment methods mainly includePsurgical resection,liver transplantation,local ablation,hepatic artery chemoembolization,radiation therapy,molecular targeted therapy,systematic chemotherapy,immunotherapy,TCM therapy and other means.Among them,the preferred treatment for stage Ia,Ib and IIa liver cancre with good liver reserve function is surgical resection.Ascites formed by hepatic vein tumor thrombus and liver cancer infiltrating peritoneum can be the main sign after liver cancre resection,and the incidence of ascites after liver cancre resection is high,with recurrence.Western medicine treatment mainly include salt restriction,diuresis,puncture for discharging ascites largerly,combined albumin supplement,etc..From the etiology and pathogenesis of TCM,it is believed that it comes from the dysfunction of liver,spleen and kidney due to liver disease for a long time.It is a kind of disease with abdominal swelling symptoms caused by the coagulation of stasis blood,Qi(气)stagnation,stagnant fluid and other pathological factors.In terms of its TCM treatment,the treatment principle is both attack and tonification,and the treatment is promoting circulation and removing stasis,soothing liver and regulating Qi,diuresis and expelling fluids,and strengthening and consolidating body resistance.This disease belongs to tympanites,a persistent disease in TCM,and the prognosis is poor.In this paper,through the analysis of Professor WANG Zhenchang’s treatment of ascites after liver cancer resection with the Rougan Huaxian granules(柔肝化纤颗粒),the author briefly discusses Professor WANG Zhenchang’s thought and treatment method of ascites after liver cancer resection,in order to provide ideas for the clinical treatment of ascites after liver cancer resection.

关 键 词：肝癌 验案 腹水 柔肝化纤颗粒 

分 类 号：R273[医药卫生—中西医结合]