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Journal of Chinese Integrative Medicine Free Full Text
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Original Article-Clinical Research
Journal of Chinese Integrative Medicine: Volume 1   January, 2003   Number 1

DOI: 10.3736/jcim20030112
Evaluation of therapeutic effects of traditional Chinese medicine combined with western medicine on breast cancer after resection: Analysis of 71 cases
1. SHEN Ye-Hua (Department of Traditional Chinese Medicine,Cancer Hospital,Fudan University, Shanghai 200032,China E-mail: yehua_sh@citiz.net)
2. SONG Ming-Zhi (Department of Traditional Chinese Medicine,Cancer Hospital,Fudan University,Shanghai 200032,China )
3. HUANG Wen-Xia (Department of Traditional Chinese Medicine,Cancer Hospital,Fudan University,Shanghai 200032,China )

Objective: To evaluate the effectiveness of traditional Chinese medicine (TCM) combined with western medicine on breast cancer after surgical resection.

Methods: Seventy-one patients with breast cancer received chemotherapy, radiotherapy, endocrine therapy and TCM following resection.

Results: None of the   patients died during the follow-up period.Fifty-seven patients were treated with TCM shortly after undergoing resection.Two recurrences (3.5%) and 6 metastases (10.5%) were observed in 8 patients, whose median disease free survival was 5.9 years.Fourteen patients didn't receive TCM until recurrence or metastasis emerged, with a median disease free survival of 3.5 years.There was significant difference between the two groups (P=0.033).

Conclusion: TCM combined with western medicine is efficient in preventing and delaying recurrence and metastasis.

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J Chin Integr Med, 2003, 1(1): 30-31

作者简介: 沈晔华(1978-),女,在读硕士研究生.  E-mail: yehua_sh@citiz.net

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      乳腺癌是女性最常见的恶性肿瘤,手术是主要的治疗方法,而手术失败的主要原因是局部复发及远处转移,因此手术后的综合治疗越来越受到重视。我们分析了1984年~2001年71例乳癌手术后中西医结合治疗的疗效,报道如下。

 
   

1  资料和方法
1.1  资料
 本组71例均为女性,年龄35~70岁,平均年龄50岁,诊断均经手术及病理切片证实。浸润性导管癌55例,浸润性小叶癌4 例,导管内癌7例,单纯癌4例,硬癌1例。临床分期Ⅰ期17例,Ⅱ期35例(Ⅱa期20例,Ⅱb期15例),Ⅲa期19例。
1.2  方法  所有患者均接受手术治疗,其中根治术30例,改良根治术34例,扩大根治术4例,保乳手术1例,单纯乳房切除术2例。64例术后行化疗4~8疗程,常用方案为CMF、CAF、 CEF、诺维本+表阿霉素,其他用药还有希罗达、吡喃比星、米托蒽醌等。20例患者术后行放疗,其中保乳手术或单纯乳房切除术后患者行全胸壁及淋巴引流区(锁骨上、下及腋窝区)放疗;根治术者病灶位于中央或内侧,病理检查有腋中、上群淋巴结转移,腋淋巴结转移超过三分之一以上,或有4个以上淋巴结转移者,行内乳区及锁骨上区放疗,以Co60或6 MV X线加9 MeV电子线照射,剂量为50Gy~60Gy左右。雌激素受体、孕激素受体阳性(两者均阳性或其中之一为阳性)患者共41例,化疗结束后口服三苯氧胺。
      所有患者病程中均接受过中药治疗,其中57例术后不久或放化疗期间即开始服用,14例在出现复发或转移后才开始中药治疗。中药以健脾疏肝理气为主,方用党参、黄芪、白术、薏苡仁、茯苓、八月札、青皮、陈皮、橘叶、橘核,加山慈菇、冰球子、白花蛇舌草、 半枝莲、鳖甲等抗癌,有不思饮食者加麦芽、六曲、山楂、鸡内金等,失眠者加酸枣仁、夜交藤、合欢皮等,贫血、白细胞减少者加生熟地、枸杞子、女贞子、当归等,放化疗或内分泌治疗后阴虚内热、潮热心烦、口干者加生地、北沙参、麦冬、石斛等,出现恶心、呕吐者加旋覆花、代赭石等。
1.3  统计分析  应用SPSS 10.0软件进行统计分析。以t检验分析不同治疗(中西医结合治疗或西医治疗)之间的差异。

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2  结 果
      全组71例患者从手术日期起随访2~19年,目前均存活,其中8例发生局部胸壁复发,占11.3%;17例发生远处转移,占23.9%(淋巴结转移7例,骨转移7例,肺转移4例,肝转移3例,胸膜转移3例)。复发或淋巴结转移患者接受再次手术或放疗,骨转移、肺转移则行放疗,肝转移行介入治疗,上述治疗的同时给予中药治疗,配合化疗和内分泌治疗。22例复发或(和)转移患者中的12例患者得到缓解,10例稳定。
      57例患者术后不久即开始以中药治疗配合放化疗、内分泌治疗,其中有2例(3.5%)出现复发,6例(10.5%)转移,再次出现病灶的8例患者的中位无病生存期为5.9年。另有14例在术后仅以西医综合治疗,再次出现病灶后(复发3例,转移8例,两者均有3例)方开始中药治疗,中位无病生存期为3.5年,与前者相比有显著性差异(P=0.033)。
      全组71例中共8例复发患者,从手术到复发的中位时间为3.8年,其中术后即开始中西医结合治疗者从手术到复发平均经历4.9年,而复发前未用中药者3.5年。17例转移患者从手术到转移的中位时间为4年,其中中西医结合治疗者5.9年,转移前单用西医治疗者3.7年,但因病例数较少而未得出显著性差异。
      放化疗过程中出现如胸闷、心烦、腹胀、纳差、恶心、失眠、口干、头晕、潮热等,给予疏肝理气以及对症的中药后多能好转。

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3  讨 论
      乳腺癌自发病起即是一种全身性疾病,是全身疾病的局部表现。因而其治疗策略也已从单一的外科治疗模式转变成为多学科综合治疗模式。传统的手术及放、化疗常造成机体气血耗伤和脏腑功能失调;中医药疗法则根据患者的个体情况,辨证与辨病结合,攻补兼施,在祛邪抗癌的同时,不伤正气,从而减轻放化疗引起的毒副反应,减少肿瘤复发和转移,提高生存期和生活质量。但纯中药治疗对根除癌灶及杀灭癌细胞较困难,因此应充分发挥两种治疗方法的优势,取长补短以提高远期疗效[1,2]
      传统中医认为乳癌多由郁怒伤肝、肝郁气滞,又因思虑伤脾、脾失健运、痰湿内蕴,以至肝脾不和,痰气互结,瘀滞成块。《医家必读·积聚》云:“积之成也,正气不足,而后邪而踞之”。有作者认为免疫功能低下是恶性肿瘤复发、转移的关键,扶正中药则可提高癌症患者免疫功能[3]。故乳癌术后宜以扶正祛邪为治则,我们以健脾疏肝益气方为主,选用党参、黄芪、白术、茯苓等以达到扶正培本,增加机体免疫力的作用;以青皮、陈皮、橘叶、橘核、八月札等理气调中,化痰除痞;选用白花蛇舌草、山慈姑、冰球子、半枝莲等抗肿瘤。我们看到,经中西医结合治疗,手术后乳腺癌患者的复发率(3.5%)、转移率(10.5%)较低。乳腺癌术后局部复发多数发生在治疗最初几年内(85%在5年内),转移也多发生在术后5年以内。但本组术后经较长时间的缓解期后才出现复发、转移(5.9年),较之单纯西医综合治疗出现晚(3.9年),两者有显著性差异。可见中医药配合治疗乳腺癌术后患者可以更好地延缓复发、转移,因此,乳腺癌术后不管病期早晚,均应及早进行中医中药配合治疗,以提高远期生存率。

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References
1. 陈国安, 陈道恒. 乳腺癌的临床与实验研究进展[J]. 上海中医药杂志, 1999, 21(5) : 42-45.
  
2. 林洪生. 乳腺癌的中西医结合治疗进展[J]. 医学理论与实践, 1997, 10(6) : 244-245.
  
3. 徐振晔, 刘嘉湘, 韩明权, 等. 中医阴阳平衡治疗癌症[J]. 上海中医药杂志, 1992, 14(3) : 10-12.
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