類風濕性關節炎合攝護腺癌放射線治療後遺症中西結合治療病例報告

The Sequel of Rheumatoid Arthritis Treatment and Prostate Cancer Radiotherapy-A Clinical Case Report of Treatment by Chinese Integrated Western Medicine

黃玨穎(Chueh-Ying Huang) ； 陳榮洲(Jung-Chou Chen)

《中西整合醫學雜誌》 13卷4期 (2011/12) Pp. 31-45

https://doi.org/10.29613/JICWM.201112.0004

摘要

這是一位68歲男性，罹患類風濕性關節炎，長期服用免疫抑制劑，有效緩解關節疼痛，後因尿失禁，初診為攝護腺肥大，血清檢查發現攝護腺腫瘤為指標PSA偏高（8.354），進一步病理切片證實合併攝護腺癌第三期B（T3bN0M0）。於是接受攝護腺組織插種近接治療（Needle implant brachytherapy）及體外放射治療，由於放療至第27次出現嚴重性的血尿，而停止治療。病患在放射線治療期間，因持續服用苦寒易化燥傷陰的類風濕性關節炎免疫抑制劑，加上放射線熱毒之傷陰津液虧損，引起白血球下降，貧血，口乾舌燥，眠差多夢，夜頻尿1hr/次，容易疲倦，因此患者於100/05/04至中醫門診尋求改善治療。至100/09/21的門診追蹤治療，患者體力及氣色改善良好，攝護腺癌影像學追蹤檢查，無復發轉移。惟夜間頻尿影響睡眠不佳，及口乾舌燥未能獲得良好改善，分析其原因，頻尿乃年老腎虛，膀胱氣化功能虛弱所致。口乾舌燥主要乃因久服西藥及放射線熱毒加重了陰津的損傷，另科學中藥療效與飲片的效益不同，亦有相當關係，故患者使用科學中藥需長期調治。

關鍵字

類風濕性關節炎 ； 攝護腺癌 ； 放射線治療 ； 中醫藥

並列摘要

This 68 y/o male patient is suffering from Rheumatoid Arthritis (RA) and taking immune-suppressants for a long time to relieve joint pain efficiently. Due to urinary incontinence, he was first diagnosed with benign prostatic hyperplasia (BPH) and found the prostate tumor maker, PSA, was elevated (8.354). For further information, trans-rectal ultrasonography-guided prostate biopsy and MRI was performed which showed adenocarcinoma of stage IIIB (T3bN0M0) and the Gleason score was 5 (2+3) Therefore, he received prostate interstitial implantation brachytherapy and external beam radiation therapy. After 27 times of radiotherapy, he stopped because of the sever hematuria.During radiotherapy, he never stopped taking immune-suppressants to control RA syndromes which are cold bitter medicinals that easily transform into dryness and damage to yin. In addition, radiotherapy is one of heat toxins which damage to liquid and wear on humor. Both treatments lead to anemia, WBC decline, easily fatigue, dry throat and tongue, insomnia, profuse dreaming, and nocturia (once every hour). Therefore, this patient came to out-patient department of Chinese medicine for improvements in May 5, 2011. From May 5 to September 21, 2011 he came to our department to follow up his condition. During the treatment of Chinese integrated western medicine, he felt good with strength and his facial complexion has improved. He kept on tumor OPD to follow up and found no metastasis. There are still some problems that syndromes such as nocturia, insomnia and dry throat and tongue have slightly improved. In order to resolve this predicament, we analyze the dynamic of disease and found patient is in old age with a vacuous kidney. However, kidney stands in interior-exterior relationship with the bladder, and a vacuous kidney leads bladder impaired qi transformation. Therefore, a vacuous kidney fails to qi transform and result in nocturia. Both side effect of western medicine and heat-toxin of the radiotherapy can aggravate the desiccation of the yin liquid. Furthermore, the effect of scientifically processed Chinese herbal medication and decocting pieces is quite different. Hence, if this patient taking only scientifically processed Chinese herbal medication, he needs to regulate for a long time.

並列關鍵字

Rheumatoid Arthritis ； Prostate Cancer ； Radiotherapy ； Chinese Medicine