放射性食管炎的中医药治疗

【作者】 张莉；

【机构】 河北医科大学第四医院暨河北省肿瘤医院中医科；

【摘要】 目的:中医药在放射性食管炎的治疗和预防中具有重要作用。方法:凡食管癌,颈部或胸部恶性肿瘤接受放疗者,出现胸、咽部烧灼疼痛,吞咽困难等放射性食管炎症状时,采用中医药方法治疗和预防。中成药有锡类散、湿润烧伤膏、云南白药、念慈庵川贝枇杷膏等,古医方有桔梗汤加减、竹叶石膏汤,沙参麦门冬汤加味等,更多的是辨证组方如“养阴解毒汤”、“养阴清热汤”、“顺食汤”、“紫甘汤”、“扶正增效合剂”等,或依据中药药理研究如甘草具有抗炎、抗变态反应、镇咳、抗肿瘤、抗放射作用、苦参含有多种生物碱成分,对移植性小鼠肉瘤S180有抑制作用等。服药方法散剂以唾液慢咽,膏剂含咽,水剂徐咽,雾化则缓慢咽下吸入气体, 药后禁食水1-2h,保证药物与食管接触以提高作用和吸收。结果:以锡类散治疗症状多在1-7天缓解。湿润烧伤膏与西药组比较有防治疗效,P<0．05。云南白药+蜂蜜治疗总有效率100％。念慈庵川贝枇杷膏+云南白药治疗疼痛分级、发生程度和时间均优于对照组,桔梗汤加减治疗症状改善总有效率达91．4％。竹叶石膏汤治疗食管炎轻、中度发生率分别为 36．7％、13．3％,无重度发生,与单纯照射组对比P<0．01, 具有防治作用。沙参麦门冬汤加味治疗食管急性损伤程度明显低干对照组,x2=5．076,P<0．05。饮食体重、生活质量均优于对照组,辨证治疗食管癌放疗者总有效率为87．0％。“养阴解毒汤”治疗食管炎发生率I级26．7％、Ⅱ级20%、Ⅲ级2．7％、无Ⅳ级,持续时间12天。“养阴清热汤”治疗症状改善总有效率94．83％,平均8．5天。“顺食汤”实验组吞咽困难有效率为100％,Karnofsky评分提高20分,实验组CR、 CR+PR及1年生存率均显著提高。动物实验证实“顺食汤”对食管粘膜放射损伤有一定的防护作用。轻度(10—20Gy)、中度(30—40Gy)、重度分别辨证治疗总有效率100％,病人均未中断放疗。“紫甘汤”雾化者吞咽困难总有效率100％, Karnofsky评分提高20分,疗效优于对照组。“扶正增效合剂”食管癌放疗者食管炎发生率明显低于对照组,甘草+蜂蜜用药12—24h咽下疼痛明显减轻,平均3．5天症状消失,与对照组比较P<0．05。苦参治疗重度食管损伤较激素治疗具有明显优势。结论:放射性食管炎的发生直接影响疗效或导致治疗失败。西医目前以止痛解痉、消炎抗菌或保护胃黏膜为主,操作复杂,副作用较多,疗效差强人意。中医治疗在改善症状和缩短病程方面,优于单纯放疗或西药对照组,临床总有效率可达100％。体现出中医治疗灵活多样,方法简便有效,无毒副作用的优势。临床研究表明,中医药能有效减少和减轻放射性食管炎的发生和程度,具有防治双重作用,中药具有综合治疗作用,优于西药的单一性,动物实验研究进一步证明中药对食管粘膜放射损伤的防护作用。更多还原

【Abstract】 Radiation esophagitis is a common complication occurring in radiotherapy. In patients who received radiotherapy for esophageal carcinoma or malignant tumors in cervical and thoracic parts, some symptoms of radiation esophagitis may be showed including burning pain in thoracic and pharyngeal portion, dys-phagia and so on. They can influence curative effect and even result in failure. Now the therapy of Western Medicine for radiation esophagitis mainly includes odynolysis, spasmolysis, antibiosis, protection of gastric mucosa and so on. But its complex operation, many side effects and unsatisfactory curative effect limit its application. The therapy of traditional Chinese midicine can avoid these disadvantages of Western Medicine. Chinese patent medicines used for treatment of radiation esophagitis include Xilei San, Shirun Shaoshang Gao, Yunnan white powder, King To Nin Jiom Pei Pa Koa and so on, Ancient medical prescriptions include Platycodon Root Decoction, Lophatheri and Gypsi Fibrosi Decoction, Ladybell Root and Radix Ophiopogonis Decoction and so on, The prescriptions in accordance with differentiation of symptoms and signs include Yang Yin Jie Du Decoction, Yang Yin Qing Re Decoction, Shun Shi Decoction, Zi Gan Decoction, Fu Zheng Zeng Xiao mixture and so forth. Furthermore basing on the modern pharmacological study, Radix Glycyrrhizae has many effects as anti-inflammatory, anti-allergy, relieving cough, anti-tumor, radioresistance, Lightyellow Sophora Root contains many kinds of alkaloids and can inhibit the transplantation tumors S180 on mice. So they are also adopted to treat the radiation esophagitis. The methods of taking medicine is different according to the different dosage form, the powder should be swallowed slowly with saliva, the slurry should be held in the mouth as long as possible before being swallowed, the aqua should be swallowed gradually, and for aerosol, the gas in the mouth should be swallowed slowly. For more sufficient contact of medicine and esophagus to improve absorbance and effect, diet and water should have been prohibited for l-2h after taking medicine. The clinical studies suggested that, the curative effect of traditional Chinese medicine for radiation esophagitis is better than it of mere radiotherapy or Western medicine on amelioration of symptoms and shortening course of disease, its total effective rate in clinic is 100%. Chinese medicine can reduce or relieve the genesis and degree of radiation esophagitis effectively, and provide methods of combined therapy, thus can avoid the shortcoming of unicity of Western medicines. It was proved further by animal studies that the traditional Chinese medicine has protection effect on radiation injury of esophageal mucosa.更多还原