PDF下载 ( 2165 KB)
原发性肝癌中医药诊疗原则及方案构建
DOI: 10.3969/j.issn.1001-5256.2021.09.002
利益冲突声明：所有作者均声明不存在利益冲突。
作者贡献声明：赵文霞负责提出研究选题，设计论文框架，起草及修订终审论文；陈欣菊负责调研整理文献及组织语音，调整文献格式。
Principles and regimens for traditional Chinese medicine diagnosis and treatment of primary liver cancer
-
摘要: 原发性肝癌治疗方案主要以手术切除、肝移植、局部治疗、全身治疗为主，但仍存在易转移、易复发、预后差等问题。多数患者确诊已为中晚期，丧失手术机会，需要多学科联合治疗，中医药治疗原发性肝癌有独特优势，能够与西医不同治疗方法结合协同增效。笔者依据原发性肝癌的不同临床分期，构建相应的中医药治疗方案：早期肝癌手术切除，扶助正气防复发；中期肝癌微创治疗，祛除癌毒增疗效；晚期肝癌对症治疗，减少疾苦保生存。Abstract: Treatment regimens for primary liver cancer mainly include surgical resection, liver transplantation, local treatment, and systemic treatment, but there are still problems such as easy metastasis, easy recurrence, and poor prognosis. Most patients are already in the advanced stage at the time of diagnosis and thus lose the opportunity for surgery and require multidisciplinary combined treatment. Traditional Chinese medicine (TCM) has unique advantages in the treatment of primary liver cancer and can exert a synergistic effect in collaboration with different Western medicine treatment methods. This article establishes TCM treatment regimens based on the different clinical stages of primary liver cancer, i.e., surgical resection for early-stage liver cancer to strengthen vital Qi and prevent recurrence, minimally invasive treatment of middle-stage liver cancer to eliminate cancer toxicity and improve efficacy, and symptomatic treatment of advanced liver cancer to reduce pain and maintain quality of life.
-
Key words:
- Liver Neoplasms /
- TCM THERAPY /
- Drug Therapy (TCD)
-
[1] FERLAY J, COLOMBET M, SOERJOMATARAM I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods[J]. Cancer, 2019, 144(8): 1941-1953. DOI: 10.1002/ijc.31937. [2] CHEN W, ZHENG R, BAADE PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338. [3] Guidelines Working Committee of the Chinese Society of Clinical Oncology. Guidelines for diagnosis and treatment of primary liver cancer (2020 Edition)[M]. Beijing: People's Medical Publishing House, 2020: 35-113.中国临床肿瘤学会指南工作委员会, 原发性肝癌诊疗指南(2020年版)[M]. 北京: 人民卫生出版社, 2020: 35-113. [4] LENG JJ, XU YZ, DONG JH. Efficacy of transarterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis: A meta-analysis[J]. ANZ J Surg, 2016, 86(10): 816-820. DOI: 10.1111/ans.12803. [5] LENCIONI R, de BAERE, SOULEN MC, et al. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data[J]. Hepatology, 2016, 64(1): 106-116. DOI: 10.1002/hep.28453. [6] LYU N, LIN Y, KONG Y, et al. FOXAI: A phase Ⅱ trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma[J]. Gut, 2018, 67(2): 395-396. DOI: 10.1136/gutjnl-2017-314138. [7] Bureau of Medical AdministrationNational Health Commission of the People's Republic of China. Guidelines for diagnosis and treatment of primary liver cancer in China (2019 edition)[J]. J Clin Hepatol, 2020, 36(2): 277-292. DOI: 10.3969/j.issn.1001-5256.2020.02.007.中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 临床肝胆病杂志, 2020, 36(2): 277-292. DOI: 10.3969/j.issn.1001-5256.2020.02.007. [8] XI SY, MINUk GY. Role of traditional Chinese medicine in the man-agement of patients with hepatocellular carcinoma[J]. World J Hepatol, 2018, 10(11): 799-806. DOI: 10.4254/wjh.v10.i11.799. [9] HEIMBACH JK, KULIK LM, FINN RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma[J]. Hepatology, 2018, 67(1): 358-380. DOI: 10.1002/hep.29086. [10] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma[J]. Hepatol, 2018, 69(1): 182-236. DOI: 10.1016/j.jhep.2018.03.019. [11] CHEN Q, SHU G, LAURENCE AD, et al. Effect of Huaier granule on recurrence after curative resection of HCC: A multicentre, randomised clinical trial[J]. Gut, 2018, 67(11): 2006-2016. DOI: 10.1136/gutjnl-2018-315983. [12] CHEN HY, YUE XQ, CHEN Z. Preliminary analysis on Chinese Medicine Therapeutic program for the liver cancer patients after operation[J]. World J Integr Tradit Western Med, 2012, 7(6): 484-486, 525. DOI: 10.3969/j.issn.1673-6613.2012.06.009陈红云, 岳小强, 陈喆. 中医治疗方案在肝癌患者术后应用的初步分析[J]. 世界中西医结合杂志, 2012, 7(6): 484-486, 525. DOI: 10.3969/j.issn.1673-6613.2012.06.009 [13] CHEN JP, ZHANG KX, TIAN CW. Research progress on chemical constituents and pharmacological actions of Rehmannia glutinosa[J]. Chin Tradit Herb Drug, 2021, 52(6): 1772-1784. DOI: 10.7501/j.issn.0253-2670.2021.06.028.陈金鹏, 张克霞, 田成旺. 地黄化学成分和药理作用的研究进展[J]. 中草药, 2021, 52(6): 1772-1784. DOI: 10.7501/j.issn.0253-2670.2021.06.028. [14] WU L, LI H, WANG F. Catalpol inhibits the proliferation, migration and metastasis of HCC cells by regulating miR-1405-p expression[J]. Mol Med Rep, 2021, 23(1): 29. DOI: 10.3892/mmr.2020.11667. [15] DUAN SL. Effects of angelica on Na+-K+-ATPase and Ca2+-Mg2+-ATPase in blood deficiency rats[J]. Gansu Animal Husbandry and Veterinary, 2021, 51(4): 50-53. DOI: 10.15979/j.cnki.cn62-1064/s.2021.04.016.段树丽. 当归对血虚大鼠Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的影响[J]. 甘肃畜牧兽医, 2021, 51(4): 50-53. DOI: 10.15979/j.cnki.cn62-1064/s.2021.04.016. [16] LIU ZR, LI L, LIU J. Protective effect and mechanism of angelica sinensis polysaccharide on rats with retinal ischemia-reperfusion injury[J]. Med Pharm J Chin PLA, 2021, 33(4): 6-9. DOI: 10.3969/j.issn.2095-140X.2021.04.002.刘宗尧, 李璐, 刘娟. 当归多糖对大鼠视网膜缺血-再灌注损伤的保护作用及机制研究[J]. 解放军医药杂志, 2021, 33(4): 6-9. DOI: 10.3969/j.issn.2095-140X.2021.04.002. [17] LO HC, HSIEH C, LIN FY. A systematic review of the mysterious caterpillar fungus ophioC ordyceps sinensis in Dong Chong Xia Cao(Dong Chong Xia Cao)and related bioactive ingredients[J]. Tradit Complement Med, 2013, 3(1): 16-32. DOI: 10.4103/2225-4110.106538. [18] HU XD, YUE Y, LUO YD. Research advances in pharmacological effects of Ophiacordyceps sinensis in treatment of liver diseases[J]. J Clin Hepatol, 2016, 32(4): 793-797. DOI: 10.3969/j.issn.1001-5256.2016.04.043.胡贤达, 岳颖, 罗远带. 冬虫夏草治疗肝脏疾病的药理作用[J]. 临床肝胆病杂志, 2016, 32(4): 793-797. DOI: 10.3969/j.issn.1001-5256.2016.04.043. [19] LYU J, GAO Y, ZHAO BN. Effect of American ginseng saponins on enhancing immunity based on zebrafish model organisms[J]. Chin Tradit Herb Drug, 2020, 51(14): 3728-3733. DOI: 10.7501/j.issn.0253-2670.2020.14.016.吕婧, 高燕, 赵渤年. 基于斑马鱼模式生物的西洋参皂苷类成分增强免疫作用研究[J]. 中草药, 2020, 51(14): 3728-3733. DOI: 10.7501/j.issn.0253-2670.2020.14.016. [20] ZHENG YY, CHEN Y, BAO YR. Study on the compatibility of effective components of Shuanglian prescription against hepatocellular carcinoma cell SMMC-7721[J]. J Chin Med Materls, 2015, 38(10): 2144-2147. DOI: 10.13863/j.issn1001-4454.2015.10.031.郑阳阳, 陈宇, 包永睿. 双莲方抗肝癌细胞SMMC-7721有效组分配伍研究[J]. 中药材, 2015, 38(10): 2144-2147. DOI: 10.13863/j.issn1001-4454.2015.10.031. [21] LI ZM, ZHANG JY, WANG G. Research progress on chemical components and pharmacological action of hedyotis diffusa in treating cancer[J]. Inf Tradit Chin Med, 2021, 38(2): 74-79. DOI: 10.19656/j.cnki.1002-2406.210215.李梓盟, 张佳彦, 王刚. 白花蛇舌草抗肿瘤化学成分及药理作用研究进展[J]. 中医药信息, 2021, 38(2): 74-79. DOI: 10.19656/j.cnki.1002-2406.210215. [22] XUE XQ, XUE JQ. Effect of Qi-regulating, blood-activating, and stasis-resolving traditional Chinese medicine combined with FOLFOX4 on patients with primary liver cancer with Qi stagnation and blood stasis[J]. Prac Clin J Integ Trad Chin Western Med, 2021, 21(8): 46-47, 62. DOI: 10.13638/j.issn.1671-4040.2021.08.022.薛新庆, 薛佳奇. 理气活血化瘀中药联合FOLFOX4化疗对原发性肝癌气滞血瘀型患者的影响[J]. 实用中西医结合临床, 2021, 21(8): 46-47, 62. DOI: 10.13638/j.issn.1671-4040.2021.08.022. [23] LIU XJ. Effect of compound Biejia Ruangan tablets combined with entecavir on liver fibrosis in patients with pulmonary tuberculosis and chronic hepatitis B[J]. Clinical Research and Practice, 2021, 6(11): 44-45, 57. DOI: 10.19347/j.cnki.2096-1413.202111016.刘学军. 复方鳖甲软肝片联合恩替卡韦对肺结核伴慢性乙肝患者肝纤维化的影响[J]. 临床医学研究与实践, 2021, 6(11): 44-45, 57. DOI: 10.19347/j.cnki.2096-1413.202111016. [24] SUN JL, WEN B, YANG XM, et al. Mechanism research of regulation of proliferation and metastasis of hepatoma cells Hep3B by Biejiajian Pill based on PI3K/AKT/GSK-3β signaling pathway[J]. China J Tradit Chin Med Pharma, 2021, 36(3): 1361-1365. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202103041.htm孙嘉玲, 文彬, 杨雪梅, 等. 基于PI3K/AKT/GSK-3β信号通路探讨鳖甲煎丸调控肝癌细胞Hep3B增殖转移的机制[J]. 中华中医药杂志, 2021, 36(3): 1361-1365. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202103041.htm [25] QI F, WANG J, WANG Z. Cinobufacini inhibits epithelial-mesenchymal transition of human hepatocellular carcinoma cells through c-Met/ERK signaling pathway[J]. Biosci Trends, 2018, 12(3): 291-297. DOI: 10.5582/bst.2018.01082. [26] YANG HN, FAN QS, YANG GW. Effects of the traditional Chinese medicine Tiaogan Lipi granules on postembolization syndrome induced by transcatheter arterial chemoembolization for hepatocellular carcinoma[J/CD]. Chin J Intervent Radiol(Electronic Edition), 2021, 9(1): 20-24. DOI: 10.3877/cma.j.issn.2095-5782.2021.01.003.杨海宁, 樊庆胜, 杨国旺. 中医调肝理脾法防治肝癌栓塞术后综合征的临床观察[J/CD]. 中华介入放射学电子杂志, 2021, 9(1): 20-24. DOI: 10.3877/cma.j.issn.2095-5782.2021.01.003. [27] LIU YG, NAN R, YAN SG. Clinical study of yipi yanggan decoction combined with percutaneous radiofrequency ablation in treating hepatitis B-related small liver cancer[J]. J Guangzhou Univ Tradit Chin Med, 2021, 2: 223-229. DOI: 10.13359/j.cnki.gzxbtcm.2021.02.001.刘永刚, 南然, 闫曙光. 益脾养肝方联合经皮射频消融术治疗乙型肝炎相关小肝癌的临床研究[J]. 广州中医药大学学报, 2021, 2: 223-229. DOI: 10.13359/j.cnki.gzxbtcm.2021.02.001. [28] JIANG X, GAO GY, WANG W, et al. Clinical study of compound sophora flavescens injection combined with radioactive ~(125)Ⅰ seed implantation in the treatment of primary liver cancer[J]. Guizhou Med J, 2017, 41(1): 39-41. DOI: 10.3969/j.issn.1000-744X.2017.01.015.蒋璇, 高广毅, 王伟, 等. 复方苦参注射液联合放射性~(125)Ⅰ粒子植入治疗原发性肝癌的临床研究[J]. 贵州医药, 2017, 41(1): 39-41. DOI: 10.3969/j.issn.1000-744X.2017.01.015. [29] CHEN XQ, CHEN XJ, JI AY. Fuzheng Xiaonao granules combined with comprehensive minimally invasive treatment of 75 cases of primary liver cancer[J]. Henan Traditional Chinese Medicine, 2019, 39(4): 576-578. DOI: 10.16367/j.issn.1003-5028.2019.04.0143.陈晓琦, 陈欣菊, 冀爱英. 扶正消瘤颗粒联合综合微创治疗原发性肝癌75例[J]. 河南中医, 2019, 39(4): 576-578. DOI: 10.16367/j.issn.1003-5028.2019.04.0143. [30] CEHN XQ, CHEN XJ, SHAO MY, et al. Effects of Fuzheng Xiaoliu granule on the expression of VEGF and HIF-1α in serum of primary hepatocellular carcinoma and its clinical significance[J]. World Sci Technol Modern Tradit Chin Med, 2020, 22(10): 3629-3635. DOI: 10.11842/wst.20190612004.陈晓琦, 陈欣菊, 邵明义, 等. 扶正消瘤颗粒对原发性肝癌血清中VEGF、HIF-1α表达的影响及临床意义[J]. 世界科学技术-中医药现代化, 2020, 22(10): 3629-3635. DOI: 10.11842/wst.20190612004. [31] WANG L, ZHAO Q, CHEN XJ, et al. Effect of Fuzheng Xiaoliu Granule on nude mice bearing hepatoma HepG2 tumor[J]. Chin J Integr Tradit West Med Liver Dis, 2020, 30(3): 231-233, 289. DOI: 10.3969/j.issn.1005-0264.2020.03.013.王磊, 赵强, 陈欣菊, 等. 扶正消瘤颗粒对HepG2肝癌裸鼠模型的影响[J]. 中西医结合肝病杂志, 2020, 30(3): 231-233, 289. DOI: 10.3969/j.issn.1005-0264.2020.03.013. [32] CHEN XQ, CHEN XJ, JI AY, et al. Effect of Fuzheng Xiaoliu granule drug-containing serum on proliferation and apoptosis-related proteins of hepatocarcinoma HepG2 cells in vitro[J]. China J Chin Med, 2018, 33(5): 701-705. DOI: 10.16368/j.issn.1674-8999.2018.05.167.陈晓琦, 陈欣菊, 冀爱英, 等. 扶正消瘤颗粒含药血清对肝癌HepG2细胞体外增殖和凋亡相关蛋白的影响[J]. 中医学报, 2018, 33(5): 701-705. DOI: 10.16368/j.issn.1674-8999.2018.05.167. [33] National Science and Technology Major Project of the Ministry of Science and Technology of China-Prevention and Treatment of Major Infectious Diseases such as AIDS and Viral Hepatitis-Research Group of 'Comprehensive Treatment Plan for Retarding Hepatitis B Related Liver Cancer Progression with Traditional Chinese Medicine', Oncology Expert Committee of Integrated Traditional Chinese and Western Medicine Branch of Chinese Medical Doctor Association, Digestive Rehabilitation Branch of Henan Rehabilitation Medical Association, et al. Expert consensus on integrated traditional Chinese and Western medicine rehabilitation after transcatheter arterial chemoembolization for primary liver cancer[J]. J Clin Hepatol, 2021, 37(7): 1545-1549. DOI: 10.3969/j.issn.1001-5256.2021.07.013.国家艾滋病和病毒性肝炎等重大传染病防治科技专项"中医药延缓乙型肝炎相关肝癌进展的综合治疗方案研究"课题组, 中国医师协会中西医结合分会肿瘤专业委员会, 河南省康复医学会消化康复分会, 等. 原发性肝癌经肝动脉化疗栓塞术后中西医结合康复专家共识[J]. 临床肝胆病杂志, 2021, 37(7): 1545-1549. DOI: 10.3969/j.issn.1001-5256.2021.07.013. [34] QIU YW, LIN LZ, LI M. Influence of Chinese medicine on life span of middle-late primary hepatic carcinoma patients: A multicenter retrospective cohort study[J]. J Guangzhou Univ Tradit Chin Med, 2014, 5: 699-705. DOI: 10.13359/j.cnki.gzxbtcm.2014.05.003.丘奕文, 林丽珠, 李猛. 多中心回顾性队列研究中医药对中晚期原发性肝癌生存期的影响[J]. 广州中医药大学学报, 2014, 5: 699-705. DOI: 10.13359/j.cnki.gzxbtcm.2014.05.003. [35] WANG XT, CHEN XJ. Clinical observation on the treatment of 60 cases of liver cancer pain with xiaonanzhitong paste[J]. Guide China Med, 2017, 15(30): 193-194. DOI: 10.15912/j.cnki.gocm.2017.30.155.王新亭, 陈欣菊. 消癌止痛贴治疗肝癌疼痛60例临床观察[J]. 中国医药指南, 2017, 15(30): 193-194. DOI: 10.15912/j.cnki.gocm.2017.30.155. [36] WANG X, JI AY, CHEN XJ. Observation of curative effect of Chinese medicine application on cancer pain[J]. J Med Forum, 2017, 38(10): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201710059.htm王晓, 冀爱英, 陈欣菊. 中药敷贴法治疗癌性疼痛的疗效观察[J]. 医药论坛杂志, 2017, 38(10): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201710059.htm -
本文二维码
计量
- 文章访问数: 688
- HTML全文浏览量: 122
- PDF下载量: 88
- 被引次数: 0
下载:
