<正>桡骨远端骨折是指桡骨远端3cm以内的骨折,是临床最常见的骨折之一。大多数的桡骨远端伸直型骨折,闭合复位石膏或夹板外固定是主要的治疗方法。特别对于低能量损伤、关节外骨折的患者,闭合复位可取得较好的效果。如果复位后达到要求,并且没有不稳定的征象,可采用夹板、

Objective:To appraise the effect of Xueshuan Tong prevent lower limb deep vein thrombosis after malignant tumor intervene chemotherapy with Xueshuan Tong.Methods:80 cases were divided into two group,test group was gave Xueshuan Tong before and after using interventional chemotherapy,the control group only was used interventional chemotherapy.Comparing the two groups after 3 months according to standards.Results:Comparing the lower limb deep vein thrombosis after interventional chemotherapy for 3 months, the difference had statistically significant(P<0.05).Conclusion:Xueshuan Tong can prevent lower limb deep vein thrombosis after malignant tumor intervene chemotherapy with Xueshuan Tong.

<正>食管癌患者晚期大多失去外科手术机会,而食管癌晚期恶性梗阻所致患者进食困难则是影响患者生存质量及生存时间的一个重要因素。但目前单纯放疗效果还很不理想,根治性放疗是治疗食管癌的重要方法之一,但效果并不理想。6个月复发率为65.6%,一年复发率为90.1%[1]。为提高其疗效,我们从2004年3月至2009年12月采用随机分组的方法,对中晚期食管癌进行放化疗联合中药(综合治疗)和常规单纯放疗(单放)的疗效观察,其结果报道如下。

目的评价肝动脉栓塞化疗联合自体树突状细胞和细胞因子诱导的杀伤细胞(DC+CIK)疗法治疗原发性肝癌的临床疗效。方法以生存期为观察指标,采用同期非随机对照方法,对2007年3月至2009年6月接受肝动脉栓塞化疗联合自体DC+CIK细胞疗法的20例原发性肝癌患者(治疗组)与单纯肝动脉栓塞化疗20例患者(对照组)比较,观察两组的生存期缓解差异。结果治疗组与对照组中位生存期分别为20个月(9～27)、l0个月(8～11),治疗组生存期明显长于对照组(P<0.05)。结论肝动脉栓塞化疗联合DC+CIK细胞疗法较单纯肝动脉栓塞化疗有可能提高原发性肝癌患者的远期生存率,延缓肝癌复发。

OBJECTIVE:To objectively assess the influence of Xiaoliu Baofei Pill (XBP) combined with chemotherapy on quality of life (QOL) of patients with stage III-IV non-small cell lung cancer (NSCLC).METHODS:Forty NSCLC patients were equally randomized into 2 groups, the treated group treated with XBP plus chemotherapy, and the control group treated with chemotherapy alone. Patients' QOL was assessed by Functional Assessment of Cancer Therapy (FACT-L) before and after treatment.RESULTS:The scores of the physical condition in the treated group was relatively stable while it lowered significantly as time went by in the control group, significant difference was shown as compared with before treatment and with that in the treated group at the same time points (P < 0.05); scores of the mood condition, the function conditions and additional concerned condition were improved gradually from the 3rd collection in the treated group, but decreased in the control group, although some improvement of mood and function conditions had revealed temporarily in the early stage of treatment. Comparison between groups showed significant difference (P < 0.05). Besides, no significant change was found in domains of patient-doctor relation and society/family condition in both groups.CONCLUSION:XBP combined with chemotherapy can obviously improve the QOL of advanced NSCLC patients.

目的:通过对既往临床研究资料的回顾性分析,探讨中晚期非小细胞肺癌(NSCLC)脾虚证患者的顸后情况.方法:共收集NSCLC 276例,按临床治疗方案分为中医组99例、中西医组103例、西医组74例,并根据中医辨证又分为非脾虚组67例,脾虚组209例(其中Ⅰ度脾虚90例,Ⅱ度以上脾虚119例).中医组采用辨病与辨证相结合的治疗方法,按肺郁痰瘀、脾虚痰湿、阴虚痰热、气阴两虚等证型给予相应汤剂治疗,并服用鹤蟾片加参一胶囊;西医组采用含铂化疗方案;中西医组采用上述2种治疗方法相结合.以平均生存期及中位生存期为主要终点指标,并综合评价影响生存期的预后因素.结果:平均生存期及中位生存期脾虚组分别为(368±19)天、(270 ±16)天,非脾虚组分别为(465±31)天、(515±107)天,2组比较,差异均有非常显著性意义(P＜0.01).平均生存期及中位生存期Ⅰ度脾虚分别为(394 4±28)天、(299±69)天,Ⅱ度以上脾虚分别为(332 4±23)天、(265±11)天,2组比较,差异无显著性意义(P＞0.05).COX比例风险回归模型分析差异有显著性意义的预后因素为:行为状态评分(PS)、乳酸脱氢酶(LDH)、血红蛋白(Hb)、I度以上脾虚(PIXU1)、性别(SEX)、中医证型(CHTYPE).根据回归系数B＞0,PS、LDH、Hb、PIXU1、SEX、CHTYPE为预后危险因子,表明级别越高,预后越差.结论:脾虚在中晚期肺癌中占有相当的比重,随着脾虚程度的加重,患者的生存期趋向缩短,提示脾虚程度与患者生存时间有一定关系,而且是影响中晚期肺癌的预后因素之一.

周宜强教授认为肺癌在祖国医学属于"肺积",治疗上率先提出"抑消三结合"的综合疗法。善用扶正大法,组方灵活,强调医食同源,药治食疗并重。注重带瘤生存,提高生活质量。

我的学生杨建宇拿来了他即将出版的《肿瘤方剂大辞典》的书稿，这本书计划将很快由中医古籍出版社出版，其中收录中医肿瘤良方验方单方上万首，其中也有我本人的和我的学生的一些验方。中医肿瘤学科的发展离不开对临床验方的收集、整理研究，而《肿瘤方剂大辞典》在这方面走在前面，为中医肿瘤学科方剂学的发展做了有益的基莫性工作。

[Objective] To observe the effects of Chinese herbal medicine in prolonging survival time in patients with non-small-cell lung cancer (NSCLC) at stages Ⅲ and Ⅳ and to search a regimen for late NSCLC. [ Methods ] A prospective, multi-center, randomized and control trial was carried out in 294 cases of NSCLC from 6 hospitals. The cases were allocated to three groups at the proportion of 1:1:1. Group A (n =99) received Chinese herbal medicine, group B ( n = 103) was treated with western and Chinese medicine and group C ( n = 92) with western medicine. Kaplan-Meier method was used to analyze the main outcome indexes of median survival time (MST) and median time to progression (TTP). [Results] In groups A, B and C, MST was 292, 355 and 236 days, the one-year accumulative survival rate was 45.38% , 48.86% and 42.17% (P = 0.4508), median TTP was 187, 239 and 180 days, and one-year accumulative non-progressed rate was 33.22 % , 37.44 % and 28.28 % (P = 0.2890), respectively. [ Conclusion ] For the sample size is small, the difference between groups is insignificant; however, MST is prolonged to 10 months in patients treated with Chinese herbal medicine and to 12 months in patients treated with the combination of Chinese herbal medicine and chemotherapy, indicating that Chinese herbal medicine is effective.

OBJECTIVE:To observe the short-term therapeutic efficacy of integrated traditional and Western medicine (ITWM) in treating non-small cell lung cancer (NSCLC) in III and IV phase. METHODS:Adopting the prospective, multi-centered, randomized and controlled method for clinical research, 324 patients who conformed to the enrolling standard were divided by ratio of 1:1:1 into the Chinese medicine (CM) group (n= 99), the ITWM group (n 03) and the Western medicine (WM) (n=92) group. The excluded or dropping off cases were 10 in CM, 6 in ITWM and 14 in WM. Clinical trials were conducted in 6 hospitals and 3 months of treatment was taken as one therapeutic course. The main observation indexes were tumor size, Karnofsky scores, body weight, adverse reaction, etc. RESULTS:The total effective rate of tumor remission in the 3 groups was 4.0%, 26.2%, and 14.1%, respectively, statistical significance was shown in the difference among them (chi = 21.72, P = 0.000 < 0.017). The total tumor stabilization rate was 66.7 , 81.6%, and 76.1 , respectively, by rectification test, no significance was shown in difference among them (chi2 = 6.052, P = 0.049 > 0.017). Karnofsky scoring showed that after 90 days of treatment, Karnofsky score raised in the CM and ITWM group, but lowered in the WM group, paired t-test showed significant difference in the ITWM group before and after treatment. The Karnofsky score in IWTM was higher than that in CM and WM with significant difference (H = 10.572, P = 0.000 < 0.05). The patients' body weight in the 3 groups were all reduced. The reduction in the CM and ITWM group was lower than that in WM group, among which, significant difference was shown in CM and WM group when compared with the same group before treatment (P < 0.05). The effect in the ITWM and CM group was better than that in WM group in aspects of improving such tumor related symptoms as cough, short breath, anorexia, fatigue, etc. Observation of adverse reaction showed that lesser hemotoxicity of III and IV grade appeared in the CM and ITWM group than that in the WM group, and significant difference was shown in counts of white blood cells, granulocytes, platelets hemoglobin, etc. among the 3 groups (P < 0.01). CONCLUSION:ITWM therapy showed better short-term efficacy in treating patients with NSCLC than CM or WM alone, showing the superiority of ITWM therapy. It can be adopted as an effective therapeutic program with low-toxicity.

Background & objective Chemotherapy is a treatment for stage III-IV non-small cell lung cancer (NSCLC), but the efficacy is not ideal. Traditional Chinese medicine (TCM) has certain effect on NSCLC. This study was to investigate various factors that affect the prognosis of advanced NSCLC, and evaluate the role of TCM in enlonging survival time of patients with stage III-IV NSCLC. Methods The NSCLC patients who meet the inclusive criteria were randomized into TCM group, combination (TCM plus NP regimen) group, and chemotherapy group, and received relevant treatments. The median survival time (MST) was calculated by Kaplan-Meier method. The prognosis of the patients was analyzed by COX regression method. Results A total of 294 stage III-IV NSCLC patients were enrolled, of which 99 were in TCM group, 103 in combination group, 92 in chemotherapy group. The MST were 292 days in TCM group, 355 days in combination group, and 236 days in chemotherapy group; the cumulative survival rates were 45.38%, 48.86%, and 42.17%, respectively (P>0.05). Cox regression analysis indicated that therapy, gender, disease course, erythrocyte sedimentation, KPS score, tumor size, and patient's weight were independent prognostic factors of stage III-IV NSCLC. Conclusion Compare with chemotherapy alone, TCM combined with chemotherapy may prolong the survival time of stage III-IV NSCLC patients.

目的:从药物经济学角度研究中医药在提高Ⅲ、Ⅳ期非小细胞肺癌患者生存期中的应用价值,探讨中晚期非小细胞肺癌的治疗方案.方法:采用前瞻性、多中心、随机、对照的方法,将符合标准病例随机分成中医组、中西医组以及西医组,观察期3个月,以瘤体有效率及稳定率、中位生存期作为效果衡量指标对三种治疗方案进行成本-效果分析.结果:共纳入合格病例294例,中医组99例,中西医组103例,西医组92例.三种治疗方案中,中医组的有效率为4.0%,稳定率为66.7%,中位生存期为292天,完成疗程人均费用18682.2元.有效率、稳定率每增加1个百分点成本分别为4624.3元、280.2元:中位生存期每提高1年成本为52.6元.中西医组的有效率为26.2%,稳定率为81.6%,中位生存期为355天,完成疗程人均费用36148.5元.有效率、稳定率每增加1个百分点成本分别为1379.2、443.3元:中位生存期每提高1年成本为101.8元.西医组的有效率为14.1%,稳定率为76.1%,中位生存期为236天,完成疗程人均费用28750.5元.有效率、稳定率每增加1个百分点成本分别为2034.7元、377.8元;中位生存期每提高1年成本为121.8元.结论:中医药是中晚期非小细胞肺癌的一种经济、有效的治疗方案.

目的探讨旋覆代赭汤加味预防以顺铂为主介入化疗引起呕吐的临床效果.方法将肿瘤患者随机分为观察组(30例)和对照组(30例),观察组在化疗前一周内服中药旋覆代赭汤加味治疗,对照组在化疗前30 min静脉注射恩丹西酮.结果观察组与对照组止吐有效率分别为70%和80%,两组差异无显著性(P＞0.05).结论旋覆代赭汤能有效预防介入化疗引起的恶心呕吐,且价格低廉,无明显副作用.

Objective:To observe the role of the TCM method for invigorating Qi and removing the phlegm in increasing the survival time of the patient with non-small cell lung cancer(NSCLC)at stages Ⅲ and Ⅳ.Methods:Muhicentral,randomized and controlled clinical epidemiological methods were adopted and the cases conformed with criteria were divided into 4 types,stagnation of the phlegm in the lung,the spleen deficiency and phlegm-dampness,Yin-deficiency and phlegm-heat,and deficiency of both Qi and Yin,and were treated based on syndrome differentiation,mainly with the methods for ventilating the lung and resolving phlegm, invigorating Qi and removing the phlegm,nourishing Yin to remove the phlegm and invigorating Qi and nourishing Yin, respectively,and the method for invigorating Qi to remove the phlegm was mainly used for treatment based on differentiation. Kaplam Meier(K-M)method was used to analyze median survival time(MST)and the time to progress(TTP)of different syndromes.Results:The total remission rate of the tumor was 9.1%,23.6%,11.5% and 13.2% in the 4 types,respectively(P< 0.05);The stable rate of the tumor was 69.7%,77.8%,69.2% and 78.9%(P>0.05);The MST was 308,401,300 and 326 days,respectively(P>0.05),and the cumulative survival rate for one year was 45.63%,51.53%,41.95% and 46.01%, respectively.Conclusion:The TCM method for invigorating Qi and removing the phlegm makes the median survival time of the patient with NSCLC at stage Ⅲ or Ⅳ reach to 9 months,and the combination with chemotherapy can reach to 12 months,being an effective therapy for late NSCLC.It can reach to 13 months for the patient of spleen deficiency and phlegm dampness.

中医学是以人与自然的统一性、脏腑经络的整体性、气血津液的协调性、辨证论治的灵活性阐明了机体系统本身及其与外部环境之间的交互作用,充分体现了复杂适应性系统的特征.具体表现在:①正气存内,邪不可干--阐明机体防御的复杂适应性系统;②生克乘侮--解释人体五脏的复杂适应性系统;③阴平阳秘--概括生理活动复杂适应性系统;④升降失衡--表现病理变化复杂适应性系统;⑤三因制宜--体现临床治疗复杂适应性系统;⑥防微杜渐--反映预防的复杂适应性系统.

我们在治疗中晚期肝癌时,重点采用补法,以滋补脾肾二脏为主,取得满意疗效.从现代病因学的观点看,虽然已确定致癌因素有多种,许多肿瘤的病因与外界环境因素有关,但他们对机体致癌的作用方式,最终必须引起机体的本身变化和反应.

周宜强教授临证30余年,在中医药防治肿瘤方面,尤其在肝癌的治疗方面,取得了较好疗效,今将其经验总结如下.

原发性肝癌(primary livers cancer,PLC,在我国尤以肝细胞癌/heptocellular carcinoma,HCC为常见)是我国常见的恶性肿瘤之一,占各种恶性肿瘤死亡率的第二位.PLC的恶性程度高,病情变化快,预后极差,目前治疗手段中仍以手术为最佳,肝动脉插管化疗栓塞治疗、放射治疗、无水酒精注射治疗等方法也确有较好疗效.但大多数患者在就诊时病情已发展到晚期,此时多数病人的体质已难以耐受这些治疗.因此,以中医药为主的中西医结合治疗肝癌就成为一种重要的辅助手段.为了探讨中药防治肝癌的机理,国内外学者已做了不少工作,并取得一定成绩,现就近年来实验研究状况综述如下.

The syndromes of diabetes being expounded by the theory of hyper functional spleen and hypo functional stomach,this paper believes that Qi Yin defficiency of spleen stomach is the fundamental of diabetes,whele heat dryness,phlegm dampness,blood stasis are the incidental.Disorder function between spleen and stomach is considered the cardinal pathogenesis of diabetes.Accordingly,it is pointed out that Reinforcing of spleen and Reducing of stomach is the fundamental treatment of diabetes.