基于子午流注理论择时取穴中药离子导入联合埋针疗法在经尿道膀胱肿瘤电切术后患者中的应用效果
Application effect of traditional Chinese medicine ion-introduction combined with embedding needle therapy in patients after transure-thral resection of bladder tumor based on"midnight-noon flow infusion"theory
王金梅 1邵海波 1王涛 1张莉1
作者信息
- 1. 上海中医药大学附属曙光医院泌尿外科 上海 201203
- 折叠
摘要
目的 观察中药离子导入联合埋针疗法在经尿道膀胱肿瘤电切术后患者中的应用效果.方法 前瞻性选取2020年1月至2023年1月在上海中医药大学附属曙光医院行经尿道膀胱肿瘤电切术患者270例,按照随机数字表法分为对照组和治疗组,每组各135例.对照组术后给予吉西他滨膀胱灌注;治疗组术后在对照组基础上结合子午流注法给予中药离子导入联合埋针治疗.对比两组术后1年的近期疗效,术后并发症的发生情况,治疗前、治疗8周后的中医证候总积分、生活质量[欧洲癌症研究治疗组织生命质量量表(EORTC QLQ-C30)]评分、肿瘤标志物[血清癌胚抗原(CEA)、糖类抗原125(CA125)]水平、免疫调节指标、血清中细胞因子[血管内皮生长因子(VEGF)、甲壳质酶蛋白40(YKL-40)]水平变化,并随访1年后复发率.结果 术后1年,观察组的总有效率为87.50％,明显高于对照组(67.46％),差异有统计学意义(P＜0.05).观察组术后总并发症发生率为11.72％,明显低于对照组(21.43％),差异有统计学意义(P＜0.05).治疗8周后,两组中医证候总积分均较治疗前降低,EORTC QLQ-C30评分均较治疗前升高,且观察组的中医证候总积分明显低于对照组,EORTC QLQ-C30评分明显高于对照组,差异均有统计学意义(P＜0.05).治疗8周后,两组血清CEA、CA125水平均较治疗前降低,且观察组的血清CEA、CA125水平均明显低于对照组,差异均有统计学意义(P＜0.05).治疗8周后,对照组患者的Treg、Th17免疫调节指标、NK细胞比例与治疗前比较,差异均无统计学意义(P＞0.05);观察组患者的Treg、Th17比例较治疗前降低,NK细胞比例较治疗前升高,且观察组的Treg、Th17比例明显低于对照组,NK细胞比例明显高于对照组,差异均有统计学意义(P＜0.05).治疗8周后,两组血清VEGF、YKL-40水平均较治疗前降低,且观察组血清VEGF、YKL-40水平均明显低于对照组,差异均有统计学意义(P＜0.05).观察组与对照组术后1年的复发率比较(1.56％vs.5.55％),差异无统计学意义(P＞0.05).结论 中药离子导入联合埋针疗法利于提高经尿道膀胱肿瘤电切术后患者的近期疗效,降低术后并发症,减轻临床症状,提高生活质量,降低肿瘤标志物水平,减少复发风险,其原因可能与增强机体免疫功能、抗血管生成有关,值得推广.
Abstract
Objective To observe the application effect of Chinese medicine ion-introduction combined with embedding needle therapy in patients after transurethral resection of bladder tumor.Methods A total of 270 patients undergoing transurethral resection of bladder tumor in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2020 to January 2023 were prospectively selected and divided into the control group and the treatment group according to the random number table method,with 135 cases in each group.The con-trol group was given gemcitabine intravesical perfusion after operation.On the basis of the control group,the treatment group was given Chinese medicine ion-introduction combined with acupuncture implantation therapy.The short-term efficacy at one year after operation,incidence of postoperative complications,total scores of TCM syndromes and quality of life[European Organization for Research and Treatment of Cancer-Quality of Life(EORTC QLQ-C30)]score,tumor markers[serum carcinogenic embryogenic antigen(CEA),carbohydrate antigen 125(CA125)]levels,immunoregulatory indicators,serum cytokines[vascular endothelial growth factor(VEGF),chitinase protein 40(YKL-40)]before treatment,after 8 weeks of treatment,and the recurrence rate after 1 year follow-up of the two groups were compared.Results One year after operation,the total effective rate of the observation group was 87.50％,which was significantly higher than that of the control group(67.46％),and the difference was statistically significant(P＜0.05).The total incidence of postoperative complications in the observation group was 11.72％,which was significantly lower than that in the control group(21.43％),and the difference was statistically significant(P＜0.05).After 8 weeks of treatment,the total scores of TCM syndromes in the two groups were lower than those before treatment,and the EORTC QLQ-C30 scores were higher than those before treatment,the total scores of TCM syndromes in the observation group were significantly lower than those in the control group,and the EORTC QLQ-C30 scores were significantly higher than those in the control group,the differences were statisti-cally significant(P＜0.05).After 8 weeks of treatment,the levels of serum CEA and CA125 in both groups were lower than those before treat-ment,and the levels of serum CEA and CA125 in the observation group were significantly lower than those in the control group,the differences were statistically significant(P＜0.05).After 8 weeks of treatment,there were no significantly significant differences in Treg,Th17 immune regulation indexes and NK cell ratio in the control group compared with those before treatment(P＞0.05).The proportion of Treg and Th17 in the observation group was lower than that before treatment,and the proportion of NK cells was higher than that before treatment,the proportion of Treg and Th 17 in the observation group was significantly lower than that in the control group,and the proportion of NK cells in the observation group was significantly higher than that in the control group,the differences were statistically significant(P＜0.05).After 8 weeks of treatment,the levels of serum VEGF and YKL-40 in the two groups were lower than those before treatment,and the levels of serum VEGF and YKL-40 in the observation group were significantly lower than those in the control group,the differences were statistically significant(P＜0.05).There was no significantly significant difference in the recurrence rate between the observation group and the control group at 1 year after operation(1.56％vs.5.55％)(P＞0.05).Conclusion Traditional Chinese medicine ion-introduction combined with needle embedding therapy is beneficial to improve the short-term efficacy of patients after transurethral resection of bladder tumor,reduce postoperative complications,alleviate clinical symptoms,improve quality of life,reduce tumor marker levels,and reduce the risk of recurrence.The reasons may be related to the enhancement of immune function and anti-angiogenesis,and it is worth promoting.
关键词
非肌层浸润性膀胱癌/中药离子导入/埋针/经尿道膀胱肿瘤电切术后Key words
Non-muscular invasive bladder cancer/Ion-introduction of Chinese medicine/Bury the needle/After transurethral resec-tion of bladder tumor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据