原发性肝癌的治疗早期主要以手术为主,中晚期肝癌也可选择肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE),局部消融治疗,靶向免疫治疗,局部姑息性放疗,但对于年纪较大、不能手术或拒绝有创性治疗的患者,中医中药作为一种治疗手段,也突显了良好的疗效.在此医案中,安徽静安中西医结合医院单纯应用中医中药治疗,患者生活质量得到了明显改善,而且治疗1年多后,肿瘤甚至完全消失,疗效显著.现对其治疗经验做一总结.

目的:总结近10年以来原发性肝癌采用中西医结合疗法的研究进展情况,从中总结学习有价值的治疗经验及理论,进一步指导临床.方法:在中国知网和万方数据库中查阅学习有关原发性肝癌的中西医结合治疗文献,主要从肝癌的病因病机、辨证治疗、中西结合治疗原发性肝癌方面的研究进展和存在问题方面进行综述,从中提取并归纳总结.结果:原发性肝癌采用中西医结合疗法具有显著优势,既能减少西医治疗的不良反应,又能控制肝癌复发、转移,部分中晚期肝癌的单独治疗方法可以采用纯中医治疗.结论:原发性肝癌中西医治疗方法较多,各有特色,各有利弊,而采用中西医结合综合疗法更能体现其优势,不仅能缓解患者的痛苦,更能提高治疗效果,是目前原发性肝癌的一个重要治疗手段.近些年中医药在预防和治疗肝癌的研究进展迅速,尤其对于晚期肝癌的研究越来越多,众多临床与实验研究及中心揭示很多中草药的抗肿瘤作用机理,临床证实其抗癌作用有效性,开辟肝癌治疗新天地.中医药治疗肝癌的最大困惑就是缺乏疗效评估对应客观指标,没有统一的辨证分型和治疗方法,无法得到广泛推广.

Objective To investigate the efficacy and safety of Ganzaoning granules in the treatment of patients with nonalcoholic fatty liver. Methods 300 patients with nonalcoholic fatty liver were recruited in our hospital between October 2015 and October 2016,and they were randomly divided into two groups,with 150 case in each group. All patients were given a regular diet and exercise therapy,and 150 patients were treated with Ganzaoning granules at the base of diet and exercise therapy. TCM syndrome scores,blood biochemical parameter, clinical efficacy and adverse reactions were observed. Results At the end of 3 month treatment,the total effective rate in the Ganzaoning granule-treated group was 93.3%,significantly higher than 61.3% in the control group (P<0.01);TCM syndrome score was(9.3±2.1),significantly lower than [(12.8±3.6),P<0.01] in the control group;serum ALT,AST,TC and TG levels were(38.1±12.4)U/L,(36.4±9.6)U/L,(2.1±0.4)mmol/L and(5.2±1.4) mmol/L,significantly lower than [(54.2±9.3)U/L,(50±11.2)U/L,(2.7±0.4)mmol/L and(6.5±1.2)mmol/L in the control,respectively,P<0.01]. Conclusion Ganzaoning granule treatment at the base of diet and exercise therapy in patients with nonalcoholic fatty liver has a good clinical efficacy and safety.

目的:探讨健脾疏肝、利湿化浊法对脂肪肝患者临床症状及肝功能的影响.方法:研究对象选自我院2015年10月~2016年10月收治的95例非酒精性脂肪肝患者,对所有患者均给予甘枣宁颗粒治疗,疗程结束后对患者进行疗效评估,同时比较治疗前后患者的临床症状体征缓解情况以及肝功能变化情况.结果:95例患者中治疗总有效率为92.63%;常见临床症状中,肝区胀痛改善82.11%,食欲减退改善89.36%,疲乏改善73.26%,上腹闷痛改善79.76%,易怒改善84.42%;95例患者治疗后ALT、AST、GGT水平均较治疗前显著下降(P<0.01).结论:健脾疏肝、利湿化浊法治疗非酒精性脂肪肝能有效缓解临床症状,改善患者的肝功能,疗效确切.