中西醫結合治療膽囊癌病例報告

這位59歲女性患者於98/9/5到嘉義基督教醫院體檢時發現肝功能指數異常(GOT: 223, GPT: 205)，因此至胃腸肝膽科門診進一步檢查，抽血檢驗並沒有感染B型及C型肝炎，腹部超音波初步檢查認爲有膽囊結石、膽囊擴張、肝內膽管脹大。醫師發現患者出現鞏膜黃疸，總膽紅素升高及急性胰臟炎，遂於98/10/20進行膽囊及膽管切除手術。病理切片結果確認爲膽囊癌，患者出院後第一天即因爲虛弱倦怠至嘉基中醫部求診。99/1/1患者再入院做第二次化療合併放射治療後體力不佳且欲嘔，持續於中醫部就診。中醫古代文獻中無膽囊癌名稱，應當散見於積聚、脅痛、黃疸等證候，一般還是認爲發病可能與濕熱相關。膽囊附於肝，與肝相爲表裡，膽腑濕熱瘀結，影響肝之疏泄及膽之中清、通降，肝膽濕熱內阻，脾胃升降、納運失司，胃氣上逆，故泛噁欲嘔，腹部脹滿。中醫藥的治則在清利肝膽濕熱，疏肝理氣兼補脾。由本病例可以看出：膽囊癌常常是在膽囊結石或膽囊炎手術後的病理切片時才被診斷發現，在西醫手術合併化學放射治療時，以中醫藥來協同治療能夠控制膽囊癌病情，使其黃疸獲得改善，並降低化學治療及放射治療的副作用，因此大大的提高膽囊癌患者的療效及生活品質。

關鍵字

膽囊癌；黃疸；化學治療合併放射治療；中醫藥

並列摘要

The 59-year-old female was diagnosed with abnormal liver index (GOT: 223, GPT: 205) when visiting Chiayi Christian Hospital on September 5(superscript th) 2009. She was referred to the department of gastroenterology for further examination. Blood work shows no sign of hepatitis B or C. The abdominal ultrasound shows gall bladder stone, extension of the gall bladder and dilation of the bile duct. Doctors found out the patient had scleral icterus, elevated level of bilirubin and acute pancreatitis. On October 20(superscript th) 2009, the operation was done to remove the gall bladder and bile duct. The result of the biopsy has confirmed gall bladder cancer. The first day after the patient was discharged from the hospital, she came to the department of Chinese Medicine because of her lack of energy and fatigue. The patient was admitted to the hospital the second time on Jan. 1st 2010 for seconde chemotherapy and radiation therapy. She felt tired and nausea and continued her treatment in the department of Chinese medicine. There is no ”gall bladder cancer” recorded in Chinese medicine literature, so it is categorized into ”accumulation”, ”hypochondriac pain”, and ”jaundice” etc. It is considered closely related to dampness and heat. Gall bladder is attached to the liver, and is the internal of liver. When dampness and heat invades gall bladder, it affects the dredging function of liver and clearing and descending function of gall bladder. When dampness and heat block internally, it affects the energy transportation of the spleen and stomach, and cause stomach qi uprising that appears as nausea and abdominal distension. The TCM principle is to clear the dampness and heat in liver and gall bladder, to smooth liver energy and supplement spleen. We can see from this case that gall bladder cancer often is diagnosed after taking the biopsy during operation of gall bladder stone or cholecistitis. During chemotherapy and radiation therapy, if TCM can be used simultaneously, the gall bladder cancer can be controlled, the jaundice will improve, and the side effects will be minimized. Therefore, the effectiveness and the quality of life can be improved dramatically.

並列關鍵字

gall bladder cancer ； jaundice ； chemotherapy and radiation therapy ； traditional Chinese medicine

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中西醫結合治療膽囊癌病例報告

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