肝内胆管癌患者338例病证分布规律研究  

Research on distribution law of disease and syndrome in 338 intrahepatic cholangiocarcinoma patients

作　　者：余宋 朱长刚[3] 徐晓婉 郭晨旭 李戬 翟笑枫 YU Song;ZHU Changgang;XU Xiaowan;GUO Chenxu;LI Jian;ZHAI Xiaofeng(Department of Traditional Chinese Medicine Oncology,The First Affliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Teaching and Training,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;College of Traditional Chinese Medicine,Anhui University of Chinese Medicine,Heifei 230012,China;Department of Integrative Medicine,Third Affliated Hospital of Naval Medical University,Shanghai 201805,China;Department of Oncology,Seventh Peoples Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]海军军医大学第一附属医院中医肿瘤科,上海200433 [2]上海中医药大学附属岳阳中西医结合医院教学处,上海200437 [3]安徽中医药大学中医学院,合肥230012 [4]海军军医大学第三附属医院中西医结合科,上海201805 [5]上海中医药大学附属第七人民医院肿瘤科,上海200137

出　　处：《中华中医药杂志》2025年第3期1429-1433,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82374540);肝癌中西医结合诊疗指南(No.ZYZB2022798);上海市科委医学创新研究专项项目(No.22Y11921200)。

摘　　要：目的:探讨肝内胆管癌(ICC)病证分布规律。方法:纳入338例ICC患者,对其病证资料进行统计分析。结果:ICC多见中老年吸烟男性患者,既往常见肝胆病史,以联合治疗为主,ECOG多见1分;肿瘤特征以单个、直径>5cm、区域淋巴结转移多见;以ⅢI、IV期,中分化腺癌多见。338例ICC中医证候依次为脾虚痰湿证97例(28.7%)、脾阳虚衰证82例(24.3%)、痰毒瘀结证57例(16.8%)、胆郁痰扰证43例(12.7%)、肝肾阴虚证34例(10.1%)、胆汁瘀滞证25例(7.4%)。与无淋巴结转移比较,淋巴结转移脾阳虚衰证、痰毒瘀结证、肝肾阴虚证占比显著升高(P<0.01),脾虚痰湿证显著降低(P<0.01);与无远处转移比较,远处转移脾阳虚衰证占比显著升高(P<0.01),脾虚痰湿证、胆汁瘀滞证显著降低(P<0.01);与Ⅲ~IV期比较,I~ⅡI期脾虚痰湿证占比显著升高(P<0.01),脾阳虚衰证、痰毒瘀结证、胆郁痰扰证、肝肾阴虚证显著降低(P<0.01)。吸烟脾虚痰湿证占比显著高于未吸烟(P<0.05);胆管扩张脾虚痰湿证占比显著高于无扩张(P<0.05)。结论:ICC以脾虚证为主,I~IV期由脾虚痰湿证向痰毒瘀结证、脾阳虚衰证发展。中医证候在ICC吸烟、胆管扩张、淋巴结转移、远处转移和肿瘤分期分布中存在特定规律。Objective:To explore the distribution law of disease and syndrome patterns in intrahepatic cholangiocarcinoma(ICC).Methods:A total of 338 patients with ICC were included,and their disease and pattern information were collected for statistical analysis.Results:ICC patients,most of them were middle-aged and elderly smokers with a history of hepatobiliary,who had undergone combination therapy,ECOG is more than 1 point.Single,>5 cm in diameter and regional lymph node metastases were the dominant tumor features.Stages II and IV were the most common tumor stages,and differentiated adenocarcinoma was a common pathological type.In 338 ICC Chinese medicine(CM)syndromes,spleen-deficiency phlegm-dampness syndrome had 97 cases(28.7%),spleen-yang depletion syndrome had 82 cases(24.3%),phlegm-toxin blood-stasis syndrome had 57 cases(16.8%),depressed gallbladder with harassing phlegm syndrome had 43 cases(12.7%),liver-kidney yin deficiency syndrome had 34 cases(10.1%)and bile stasis syndrome had 25 cases(7.4%).The proportion of pattern of spleen-yang depletion,phlegm-toxin blood-stasis syndrome,liver-kidney yin deficiency syndrome in lymph node metastasis was higher than that of non-lymph node metastasis(P<0.01),the proportion of pattern of spleen-deficiency phlegm dampness was lower than that of non-lymph node metastasis(P<0.01).The proportion of pattern of spleen-yang depletion in distant metastasis was higher than that of non-distant metastasis(P<0.01),the proportion of pattern of spleen-deficiency phlegm-dampness,bile stasis syndrome in distant metastasis was lower than that of non-distant metastasis(P<0.01).The proportion of pattern of spleen-deficiency phlegm-dampness in tumor stage I-II was higher than that of stage II-IV(P<0.01),the proportion of pattern of spleen-yang depletion,phlegm-toxin blood-stasis syndrome,depressed gallbladder with harassing phlegm syndrome,liver-kidney yin deficiency syndrome in tumor stage I-I was lower than that of stage II-IV(P<0.01).The proportion of pattern of spleen-deficiency phlegm-damp

关 键 词：肝内胆管癌 中医证候 分布规律 中西医整合 病证结合 

分 类 号：R735.7[医药卫生—肿瘤]