附子类方改善宫颈癌放疗后淋巴水肿1例
Improvement of Lymphedema After Radiotherapy of Cervical Cancer with Subclass Prescription: A Case Report
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1.辽宁中医药大学附属医院,沈阳 110032
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王文萍,陈璐,李翔宇,等.附子类方改善宫颈癌放疗后淋巴水肿1例[DB/OL].(2023-11-10)[2023-11-10].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43820802&Fpath=home&index=0&lang=zh
WANG Wenping,CHEN Lu,LI Xiangyu,et al.Improvement of Lymphedema After Radiotherapy of Cervical Cancer with Subclass Prescription: A Case Report[J].,
王文萍,陈璐,李翔宇,等.附子类方改善宫颈癌放疗后淋巴水肿1例[DB/OL].(2023-11-10)[2023-11-10].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43820802&Fpath=home&index=0&lang=zh DOI:
WANG Wenping,CHEN Lu,LI Xiangyu,et al.Improvement of Lymphedema After Radiotherapy of Cervical Cancer with Subclass Prescription: A Case Report[J]., DOI:.
淋巴水肿是由于乳腺癌、妇科恶性肿瘤术后或放化疗后等原因造成淋巴管道不通或者狭窄,导致淋巴液回流障碍而滞留在组织中引起肿胀的疾病,“湿”“瘀”“虚”是主要病机,病位在里,病性多属虚实夹杂。淋巴水肿治疗不易,若独辟蹊径,灵活运用附子之振奋机能,则起效颇快。王文萍教授长期致力于《伤寒论》理论与经方研究,临证治疗疑难病症经验丰富。文章通过1则宫颈癌放疗后淋巴水肿的医案来详述王文萍教授的学术思想和治疗经验,指导临床应用。,病史摘要,2,患者,女,62岁。2022年5月11日初诊,小便不利6年,外阴及小腹局部(位于耻骨联合上方,面积约6cm×6cm)肿胀3年伴左下肢膝关节以上淋巴水肿2个月。六年前患者因宫颈鳞癌于外院行子宫、附件及部分阴道切除术,术后出现排尿困难、尿不净。每次排尿时需要使劲、咳嗽、跺脚等做好准备工作才能排尿。术后4个月才将其导尿管摘除,摘除后陆续出现过肾盂肾炎、肾积水。2019年宫颈癌复发,行放化疗,放疗后出现外阴及小腹肿胀及疼痛,排尿困难加重,需要依靠导管留置性导尿或间歇性导尿。2022年3月左下肢膝关节以上也出现肿胀。中医诊断 1.水肿;2.癃闭 肾阳亏虚,热毒伤络西医诊断 1.宫颈癌放疗后淋巴水肿;2.宫颈癌术后尿潴留干预措施 中药汤剂口服,同时配合手法淋巴引流及弹力绷带加压包扎治疗并对患者进行淋巴水肿引流及弹力绷带包扎自我操作的培训。疗效转归 患者服中药3月余,由最初小便不利(尿等待、尿不净等)变为排尿顺畅,残余尿量由最初200 mL降到50 mL左右。解决了多年来小便不利的困扰。在整个治疗过程中,患者左下肢膝盖上缘20 cm周径从疗前到疗后,减少了6.1 cm。左下肢水分量比用药前减少270 mL。外阴、小腹及左下肢膝关节以上肿胀均痊愈。
Summary of case history, Patient, female, 62 years old. Initial diagnosis on May 11, 2022, dysuria for 6 years, swelling of the vulva and lower abdomen (located above the pubic symphysis, with an area of about 6 cm*6 cm) for 3 years, and lymphedema above the knee joint of the left lower extremity for 2 months. Six years ago, the patient underwent hysterectomy, adnexectomy, and partial vaginectomy for cervical squamous cell carcinoma. After the operation, he developed dysuria and impure urine. Every time you urinate, you need to strain, cough, stomp your feet, etc. to prepare to urinate. The catheter was removed only 4 months after the operation, and pyelonephritis and hydronephrosis occurred successively after the removal. Cervical cancer recurred in 2019 and underwent radiotherapy and chemotherapy. After radiotherapy, vulva and lower abdomen swelling pain, and difficulty in urination were aggravated. Indwelling catheterization or intermittent catheterization was required. In March 2022, swelling also appeared in the left lower extremity above the knee joint.,TCM diagnosis, 1. Edema;2. Long closure deficiency of kidney yang, heat, and toxin damaging the collaterals.,Western medicine diagnosis, 1. Lymphedema after cervical cancer radiotherapy;2. Urinary retention after cervical cancer surgery,Therapeutic methods, Oral Chinese medicine decoction, combined with manual lymphatic drainage and elastic bandage compression treatment, and patients were given training in lymphedema drainage and elastic bandage self-operation.,Clinical outcomes, The patient took traditional Chinese medicine for more than 3 months, and the initial difficulty in urination (urination waiting, unclean urine, etc.) changed to smooth urination, and the residual urine volume decreased from the initial 200 ml to about 50 ml. Solved the problem of poor urination for many years. During the entire treatment process, the 20 cm circumference of the upper edge of the knee of the patient's left lower extremity has decreased by 6.1 cm from before treatment to after treatment. The water content of the left lower extremity decreased by 270 ml compared with that before treatment. The swelling of the vulva, lower abdomen, and the left lower extremity above the knee joint was cured.
宫颈癌放疗淋巴水肿附子
cervical cancerradiotherapylymphedemaaconite
李佳忻,王文萍,王华伟,等.肿瘤术后或放疗后淋巴水肿的经方研究[J].实用中医内科杂志,2021,(06):105-108.
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陈林,张丽,戴云,等.使药郁金对君药丹参药代动力学的影响研究[J].中国民族医药志,2007,(07):55-57.
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