51例早期胃癌及癌前病变患者中医证型特点及内镜黏膜下剥离术的影响  

Characteristics of the distribution of traditional Chinese medicine syndromes and the impact of endoscopic submucosal dissection surgery on 51 patients with early gastric cancer and precancerous lesions

作　　者：欧阳劲光 查安生[1] OUYANG Jinguang;ZHA Ansheng(Department of Spleen and Stomach Disease,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei,230038,China)

机构地区：[1]安徽中医药大学第一附属医院脾胃病科,合肥230038

出　　处：《中国中西医结合消化杂志》2025年第2期100-105,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：第七批全国老中医药专家学术经验继承项目(No:20220073号);安徽省查安生名中医工作室项目(No:[2020]10号);安徽省中医药领军人才培养对象项目(No:[2018]23号);安徽省卫生健康委科研项目(No:AHWJ2021a021);安徽省自然科学基金(No:1608085MH186);安徽省临床重点专科项目(No:[2020]243号)。

摘　　要：目的:研究早期胃癌及胃癌前病变的中医证型分布特点以及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)对其中医证候变化的影响,从而指导中医药辨证治疗。方法:采用横截面研究方法,回顾2020年5月—2023年8月行胃黏膜病变ESD术,且术后病理明确早期胃癌及癌前病变的患者共51例。建立数据库,分析中医证型分布特点及相关影响因素以及ESD术对于中医证型的影响。结果:51例早期胃癌及胃癌前病变患者中医临床症状主要为胃胀、嘈杂、胃痛。中医辨病以胃痞、胃痛最多,证型分布以脾胃虚弱证(27例)>肝胃不和证(11例)>脾胃湿热证(10例)>胃络瘀阻证(3例)。中医证型分布在年龄分布、病理分级、病灶大小、幽门螺杆菌感染方面差异有统计学意义(P<0.05)。采用logistic回归模型进行多因素分析发现,年龄≤60岁(P<0.05,OR=4.646)、病灶直径≤2 cm(P<0.05,OR=5.347)可增加脾胃虚弱证发生的风险,差异有统计学意义。ESD术后患者舌象表现以舌淡红、白腻苔为主,胃胀、嘈杂、纳差、腹泻、疲乏、畏寒等临床症状积分较术前增加,差异有统计学意义(P<0.05)。结论:早期胃癌及胃癌前病变患者的中医证型以脾胃虚弱证最多见。年龄≤60岁、病灶直径≤2 cm、低/高级别异型增生、幽门螺杆菌感染与脾胃虚弱证的发生有相关性。年龄≤60岁、病灶直径≤2 cm可能是脾胃虚弱证发生的独立危险因素。脾胃虚弱是早期胃癌及胃癌前病变的主要病机。ESD术可导致早期胃癌及胃癌前病变患者术后脾胃虚弱、运化无力、痰湿内停。Objective To study the distribution characteristics of traditional Chinese medicine(TCM)syndrome types associated with early gastric cancer and gastric precancerous lesions and the impact of endoscopic submucosal dissection(ESD)on TCM symptom changes,thereby informing TCM syndrome differentiation treatment.Methods A cross-sectional study method was used to review the total number of patients who underwent ESD for gastric mucosal lesions from May 2020 to August 2023.The number of patients whose postoperative pathology confirmed early gastric cancer and precancerous lesions was 51 cases.A database was established,and the distribution characteristics of TCM syndrome types,associated influencing factors and the impact of ESD on TCM syndrome types were analyzed.Results Gastric bloating,noise,and stomachache were the main TCM clinical symptoms of 51 patients with early gastric cancer and gastric precancerous lesions.According to TCM,gastric pimples and stomachaches were the most common diseases.The distribution of syndromes was as follows:weakness of the spleen and stomach(27 cases)>disharmony of the liver and stomach(11 cases)>dampness and heat in the spleen and stomach(10 cases)>stagnation of stomach collaterals(3 cases).The distribution of TCM syndrome types exhibited significant variation across age distribution,pathological grade,lesion size and Helicobacter pylori infection,with statistical significant(P<0.05).A logistic regression model was employed for multivariate analysis,revealing that age≤60 years old(P<0.05,OR=4.646),lesion diameter≤2 cm(P<0.05,OR=5.347)increased the risk of spleen-stomach weakness syndrome,with statistical significance.The tongue appearance of patients after ESD was mainly pale red tongue,white and greasy coating,and the scores of clinical symptoms such as gastric bloating,noise,anorexia,diarrhea,fatigue,and chills were increased compared with those before surgery,with statistically significant(P<0.05).Conclusion The predominant TCM syndrome type in patients with early gastric cancer

关 键 词：早期胃癌 胃癌前病变 中医证型 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]