济生乌梅汤保留灌肠联合nCRT治疗局部进展期直肠癌的疗效观察  

Therapeutic efficacy of Jisheng Wumei Decoction retention enema combined with nCRT in the treatment of locally advanced rectal cancer

作　　者：董超群 沈鹏 王雨豪 欧俊明 彭榆翀 王晓丽 王洪波[1] Dong Chaoqun;Shen Peng;Wang Yuhao;Ou Junming;Peng Yuchong;Wang Xiaoli;Wang Hongbo(Department of General Surgery,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Oncology,Chongqing Prison Central Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院普外科,重庆400021 [2]重庆市监狱中心医院肿瘤内科,重庆400021

出　　处：《保健医学研究与实践》2024年第7期46-51,共6页Health Medicine Research and Practice

基　　金：重庆市科技计划项目科研机构绩效激励引导专项项目(jxyd2020-8)。

摘　　要：目的探讨济生乌梅汤保留灌肠联合直肠癌新辅助放化疗(nCRT)治疗局部进展期直肠癌的疗效,以及对放射性肠炎的防治效果,以期为临床治疗提供参考。方法选取2020年1月—2023年12月重庆市中医院普外科收治的直肠癌患者47例为研究对象,采用随机数字表法将患者分为观察组(n=24)和对照组(n=23)。观察组患者治疗方案:卡培他滨+奥沙利铂方案化疗联合放疗(CapeOX-CRT)+济生乌梅汤保留灌肠。对照组患者治疗方案:CapeOX-CRT+安慰剂保留灌肠。比较2组患者放疗前后血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平。比较2组患者新辅助治疗后病灶病理缓解情况,指标包括cTNM、ypTNM分期、美国国家综合癌症网络(NCCN)肿瘤消退分级(TRG)。比较2组患者同步放化疗完成后不同级别急性放射性直肠炎的发生情况。结果放疗前,2组患者IL-6、IL-8、TNF-α及SOD水平比较,差异无统计学意义(P>0.05)。放疗后,2组患者IL-6、IL-8、TNF-α水平均高于放疗前,但观察组低于对照组,差异均有统计学意义(P<0.05)。放疗后,观察组患者SOD水平高于对照组,差异有统计学意义(P<0.05)。观察组患者放射性肠炎发生率、重度放射性肠炎发生率均低于对照组,差异均有统计学意义(P<0.05)。2组患者cTNM、ypTNM、TRG分级比较,差异无统计学意义(P>0.05)。通过对比2组患者大体标本,可以观察到对照组患者肠壁黏膜及其系膜充血水肿较观察组明显,同时HE染色可以看到对照组患者标本肿瘤组织间隙大量炎症细胞浸润,观察组患者标本组织疏松,炎症细胞散在分布。结论济生乌梅汤保留灌肠可以显著降低nCRT治疗过程中患者放射性肠炎的发生率,减少患者治疗过程中的不适感,进而提高患者的依从性,值得临床推广应用。Objective To explore the efficacy of Jisheng Wumei Decoction retention enema combined with neoadjuvant chemoradiotherapy(nCRT)in the treatment of locally advanced rectal cancer and its effect on the prevention and treatment of radiation proctitis,in order to provide a reference for clinical treatment.Methods A total of 47 patients with rectal cancer treated in the Department of General Surgery,Chongqing Traditional Chinese Medicine Hospital from January 2020 to December 2023 were selected as the study participants and randomly assigned to an observation group(n=24)and a control group(n=23)using the random number table method.The treatment plan for the observation group included capecitabine plus oxaliplatin chemotherapy combined with radiotherapy(CapeOX-CRT)and Jisheng Wumei Decoction retention enema.The control group's treatment plan included CapeOX-CRT plus placebo retention enema.The levels of serum tumor necrosis factor α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),malondialdehyde(MDA),and superoxide dismutase(SOD)before and after radiotherapy in both groups of patients were compared.The pathological response of the lesions after neoadjuvant therapy was compared,including cTNM,ypTNM staging,and the American National Comprehensive Cancer Network(NCCN)tumor regression grading(TRG).The occurrence of acute radiation proctitis of different grades after concurrent chemoradiotherapy was compared between the two groups.Results Before radiation therapy,there was no statistically significant difference in the levels of IL-6,IL-8,TNF-α,and SOD between the two groups(P>0.05).After radio therapy,the levels of IL-6,IL-8,and TNF-α in both groups were higher than before radiotherapy,but the observation group was significantly lower than the control group(P<0.05).After radio therapy,the level of SOD of the observation group was higher than the control group,with statistically significant differences(P<0.05).The incidence of radiation proctitis and severe radiation proctitis in the observation group was significantly lo

关 键 词：济生乌梅汤 新辅助放化疗 局部进展期直肠癌 放射性肠炎 

分 类 号：R657.1[医药卫生—外科学]