直肠癌术后伴低位前切除综合征验案举隅  

A case of low anterior resection syndrome after rectal cancer surgery

作　　者：吴柯玫 金鑫 吴金玲 王丽[1] 尹丽丽[1] 程港晨 WU Kemei

机构地区：[1]天津中医药大学第一附属医院国家中医针灸临床医学研究中心,天津300381 [2]天津中医药大学研究生院,天津301617

出　　处：《中医临床研究》2024年第5期111-114,共4页Clinical Journal Of Chinese Medicine

摘　　要：结直肠癌是常见的恶性肿瘤疾病,是指在多种致癌因素作用下结直肠黏膜上皮细胞发生恶性变化。近些年来直肠癌发病率有逐年上升趋向,手术切除是有效的治疗手段,西医治疗短期有一定效果,长期效果欠佳。直肠癌术后易引起胃肠功能紊乱,常伴随腹泻等不良反应,加重患者痛苦从而阻碍了术后康复,严重影响患者的生活质量与身心健康,对患者的生存期造成不良影响。中医药治疗直肠癌术后泄泻可发挥主导优势,弥补了西医手术治疗直肠癌伴随的术后腹泻等不足,中医药辨证论治、对证治疗可显著改善临床症状,减轻患者心理压力和生活负担,提高临床疗效,进而改善患者的后续治疗进程和生活质量。在临床治疗中,患者病情瞬息万变,具体辨证亦随之相应改变。久泻病机多为脾胃虚弱、肾阳不足,临床上多选用四神丸以温补脾肾、固涩止泻,在本验案中尹丽丽副主任医师辨证选用自拟方癌后止泻方对证施治。现笔者将跟师学习,整理记录,从病因病机、病情转归、用药情况等方面对尹丽丽副主任医师治疗直肠癌术后腹泻的诊治思路进行归纳分析,总结临证经验和治则。故文章介绍四神丸以及癌后止泻方治疗直肠癌术后伴腹泻的1例临床验案,在一定程度上具有临床意义,旨在为临床诊治提供参考方向。Colorectal cancer is a common malignant tumor disease,which refers to the malignant change of colorectal mucosal epithelial cells under the action of various carcinogenic factors.In recent years,the incidence of rectal cancer tends to increase year by year,and surgery is an effective treatment,but Western medical treatment has certain effect in the short term,but the long-C term effect is not good.Postoperative rectal cancer is prone to gastrointestinal dysfunction,often accompanied by diarrhea and other adverse reactions,which aggravates patients’pain and hinders their postoperative recovery,seriously affecting their quality of life and physical and mental health,and adversely affecting their survival.TCM medicine can play a dominant role in the treatment of postoperative diarrhea in rectal cancer,which can make up for the deficiencies of postoperative diarrhea accompanying the surgical treatment of rectal cancer in Western medicine.In the clinical treatment,the patient’s condition changes rapidly,and the specific diagnosis changes accordingly.The pathogenesis of prolonged diarrhea is mostly due to the weakness of spleen and stomach and the deficiency of kidney Yang(阳),so clinically,Sishen Wan(四神丸)is often used to warm the spleen and kidney,consolidate and stop diarrhea.In clinic the records were organized,the diagnosis and treatment ideas of Dr.YIN Lili’s the Aihou Zhixie prescription(癌后止泻方)were summaried and analyzed from the aspects of etiology,disease regression and medication,and the clinical experience and treatment rules was summarized.Therefore,this paper introduces a clinical case of postoperative diarrhea with rectal cancer treated with Sishen Wan and the Aihou Zhixie prescription,which has clinical significance to a certain extent and aims to provide a reference direction for clinical diagnosis and treatment.

关 键 词：直肠癌术后 重度低位前切除综合征 泄泻 四神丸机制 癌后止泻方 

分 类 号：R735.37[医药卫生—肿瘤]