中西醫合作治療肺癌合併上腔静脈综合症之病例

在台灣地區所有的癌症，有發病率和死亡率中，肺癌排名都是第一位。但肺癌目前在經各種西方醫學治療後，平均五年生存率約為10%左右。所以我找尋更好的治療方式是目前國際上積極發展的方向，其中中醫藥部分亦是大家所重視的部分。中醫藥治肺癌應強調中西結合，與手術、放、化綜合實施。採用整體觀、辨證施治、辨證痛辦病相結合的中醫綜合治。此病例為長期大量抽煙罹患鱗狀上皮細胞肺癌之病人，經過西醫化學藥物治療腫瘤縮小，但二個多月後，腫瘤再度擴大出現心包膜積水，進行心包膜引流與pericardial window手術，但呼吸困難而使用呼吸器協助呼吸並且氣切。一個月後腫瘤壓迫上腔靜脈，出現了喘及上半身水腫之上腔靜脈綜合徵，西醫使用口服5-FU、類固醇及利尿劑等藥療效不佳，此時會診中醫，處方以補心氣陰之品，補腎陽、健脾及治標之清熱化痰之品幫助病人改善症狀，提昇其生活品質。在處方過程中，提出了醫者需重視病人體質及疾病機轉的重要性，才能達到良好療效。

關鍵字

肺癌；上腔靜脈綜合徵；中藥

並列摘要

Recently, both the incidence and mortality rates of lung cancer were the first of all cancers in Taiwan. However, the 5-year survival rate of lung cancer was only about 10% even though the patient had received all manner of medical treatments of modern medicine. Searching for the better therapy for lung cancer is the most active work currently, and the traditional Chinese medicine (TCM) plays an important role in these treatments. In the view of ”patient centered care” the surgery, chemotherapy and radiotherapy could be combined with TCM to give a ”holistic care” to the patient. The 78-year-old smoker suffered from squamous cell carcinoma of lung, and the tumor size reduced after chemotherapy. However, the disease progressed complicated with pericardial effusion and dyspnea. He received the ”pericardial window operation” and ”tracheostomy”. One month later, superior vena cava syndrome occurred due to the tumor compressing the SVC, complicated with the symptoms of dyspnea and edema of the upper part of his body. Since the effect of oral 5-FU, steroid, and diuretics were in vain, the Chinese medical doctors were consulted. We prescribed a remedy to supply the ”heartqi and yin” ”kidney yang”, and strengthen the ”spleen qi” for his pathological physical constitution, and also prescribed the drugs which ”clearing heat” and ”transforming phlegm” for improving the symptoms. After that, the edema and dyspnea relieved, and the life quality was improved, too. In this article, we pointed out that the medical team should pay much attention to the physical constitution of the patient and the pathophysiology of the disease, then we can improve the curative effect.

並列關鍵字

lung cancer ； superior vena cava syndrome ； Chinese medicine

國際替代計量

中西醫合作治療肺癌合併上腔静脈综合症之病例

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