健脾理气法治疗结直肠癌的回顾性研究及预后分析  

Retrospective Study and Prognostic Analysis of the Treatment of Colorectal Cancer with the Method of Jianpi Liqi

作　　者：赵泉景 侯佳伟 许阳贤[1] ZHAO Quanjing;HOU Jiawei;XU Yangxian(Second Department of General Surgery Longhua Hospital Affiliated to Shanghai University of TCM,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院普外二科,200032

出　　处：《医学研究杂志》2024年第11期22-26,共5页Journal of Medical Research

基　　金：国家重点研发计划项目(2022YFC3500204);上海市2022年度“科技创新行动计划”自然科学基金资助项目(22ZR1462000);上海市中医肿瘤临床医学研究中心科研项目(21MC1930500)。

摘　　要：目的 探索健脾理气法对结直肠癌(colorectal cancer, CRC)术后患者生存时间的影响,分析筛选出影响CRC术后患者预后的独立因素。方法 回顾性收集2015年7月~2022年12月就诊于上海中医药大学附属龙华医院普外科的254例CRC术后患者,根据患者在术后是否使用中药以及是否以健脾理气为主要治疗方法将其分为健脾理气中药组(n=51)、非健脾理气中药组(n=126)和西医组(n=77)。把总生存期作为主要观察指标,Kaplan-Meier法绘制生存曲线,Log-rank检验比较总生存率的差异;引入COX比例风险模型,先进行单因素COX回归分析初步筛选出影响CRC术后预后的因素,然后采用逐步回归法进行多因素分析,最终筛选出影响CRC术后患者预后的独立相关因素。结果 健脾理气组中药组、非健脾理气中药组和西医组患者的总生存率差异无统计学意义。单因素COX回归分析结果显示,病理分期Ⅲ~Ⅳ期、阳性淋巴结数目、神经/脉管侵犯、手术方式和胆管疾病为影响CRC术后预后的因素(P<0.05)。多因素COX回归分析结果显示,更多的阳性淋巴结是影响CRC术后预后的独立危险因素,腹腔镜手术和有胆道疾病为CRC术后预后的独立保护因素(P<0.05)。结论 相较于纯西医治疗,联合健脾理气法为主要治则的中医治疗具有延长CRC术后患者生存时间的趋势;更多的阳性淋巴结是影响CRC术后预后的独立危险因素,腹腔镜手术和有胆管疾病为CRC术后预后的独立保护因素。Objective To explore the effect of Jianpi Liqi(JPLQ)on the survival time of postoperative patients with colorectal cancer(CRC),and screen the independent factors affecting the prognosis of these patients.Methods A retrospective study was conducted on 254 postoperative CRC patients who were admitted to the Department of General surgery,Longhua Hospital Affiliated to Shanghai University of TCM from July 2015 to December 2022.According to the use of ttraditional Chinese medicine(TCM)or JPLQ after the operation,they were divided into three groups:JPLQ group(n=51),non-JPLQ group(n=126)and western medicine group(n=77).The overall survival time was taken as the main observation index,then the survival curve was drawn by Kaplan-Meier,and the difference of survival rate was compared by Log-rank test.The COX proportional hazard model was introduced to screen the statistically significant factors,univariate COX regression analysis preliminarily screened out the factors affecting the postoperative prognosis of CRC patients,then stepwise regression was used for multivariate analysis to screen out the independent related factors that ultimately affect the prognosis of postoperative CRC patients.Results There was no significant difference among the survival curves of JPLQ group,non-JPLQ group and western medicine group.The results of univariate COX regression analysis showed that pathological stageⅢ-Ⅳ,number of positive lymph nodes,nerve/vascular invasion,mode of operation and biliary diseases were significant factors that may affect postoperative prognosis of CRC patients(P<0.05).The results of multivariate COX regression analysis showed that more positive lymph nodes were the independent risk factor affecting the prognosis of CRC,while receiving laparoscopic surgery and having biliary diseases were independent protective factors affecting the prognosis of CRC(P<0.05).Conclusion Compared with single western medical treatment,combination with western medicine and TCM especially represented as JPLQ has a tendency to prolong

关 键 词：结直肠癌 中药 回顾性研究 预后 

分 类 号：R273[医药卫生—中西医结合]