甲狀腺癌術後併發症與復發之中醫治療病例探討

本文探討一位罹患甲狀腺癌的病患，術後於中醫藥介入治療後，逐步改善不適癥狀，即西醫常規手術切除所出現的諸多併發症，如：喉返神經損傷、水腫導致聲帶功能異常，以及眩暈、夜尿頻數、倦怠乏力、胸肋悶脹等中醫辨證屬「肺痿」的現象;另一方面，於長期的病例追蹤，也發現抑制癌幹細胞活化的中藥療法，得以平穩控制癌症的復發或轉移（如圖一、癌監測標記Tg平穩控制），但令人惋惜的，其後病患於未據實以告的情況下，自行注射德國胎盤素長達半年，致使甲狀腺癌肺部轉移，此乃過用類屬「補性藥物」的胎盤素，而有活化癌幹細胞之慮，惟此次癌症復發來勢兇猛，加上病患腫瘤心身症狀明顯、意志消沈，最終仍不敵病痛而辭世（如圖二、癌症復發後Tg控制情況），在其生命期最後一年內，中醫治療轉為以減緩不適症狀、提升病患存活期生活品質為首要目標。在各階段療程的虛實夾雜病癥中，要準確診斷病患的證候表現究竟為術後體虛陽亢抑或癌症復發，皆需倚靠臨診中醫師的豐厚經驗，洞悉病勢發展的蛛絲馬跡，方能掌握扶正或袪邪的用藥比例，特別是要把握原則：腫瘤體質需慎用補性藥物且不可久用，同時必須重用清熱藥物。文中首先簡介甲狀腺腫瘤的中、西醫治療方法，再以育生中醫診所李政育醫師的臨床醫案為例，作為辨證論治之題材。中醫師李政育臨床四十餘年，累積防治癌症與癌幹細胞的基礎研究、專利與臨床，本文即依其醫案整理而來，發現中醫藥介入治療確能有效補救甲狀腺癌經手術全切除的喉返神經水腫致失音，且對於抑制癌幹細胞的活化、延緩癌症復發與轉移，成效更是卓著，其治療思路值得中西醫同道參酌與深入研究。

關鍵字

甲狀腺癌；中醫治療癌症術後併發症；喉返神經水腫；甲狀腺癌術後失音；腫瘤心身症；癌幹細胞的中藥防治；李政育中醫師；育生中醫診所

並列摘要

This paper presents the Chinese medicine medicinal treatment of a thyroid cancer patient who incurred postsurgical complications of recurrent laryngeal nerve edema that damaged the vocal cords, dizziness, nocturia, fatigue, and ribside distention. After being administered TCM medicinals, the patient showed noticeable gradual improvement of the discomforting symptoms arising from the iatrogenic surgical complications. In TCM, this condition can be identified as ＂lung wilting＂ pattern. Furthermore, long-term follow-up of the patient's case reveals that administration of TCM medicinals inhibits cancer stem cell activity and thus provides stable control of the cancer, reducing the chances of recurrence or metastasis (see Figure 1, Cancer Monitoring Marker Tg Stable Control). Regrettably, the patient did not provide an accurate report about the extent of her drug treatment regimen, specifically the fact that the patient self-administered injections of a German placenta extract for up to six months, which resulted in the thyroid cancer cells metastasizing to the lung. Used in excess placenta extract can be viewed as a type of potent supplementing medicinal that may activate cancer stem cells. And this time the recurrence was extremely fierce, which was further compounded by the patient presenting with concomitant cancer psychosomatic symptoms of depression and losing the will to fight. Eventually, the patient succumbed to the painful discomforts of disease and passed away (see Figure 2, Tg Control After Cancer Recurrence). During the last year of life, the primary Chinese medicine therapeutic objective was modified to focus on mitigating the discomforting symptoms, extending survival time, and improving quality of life. In each stage of complicated vacuity-repletion complex pattern condition, it was essential to conduct careful pattern identification in order to determine if the postsurgical condition was vacuity yang hyperactivity or if it was cancer recurrence. This required a Chinese medicine physician with an abundance of experience who can obtain deep insights into the manifestation of disease to construct a formula composition that contains appropriate ratios of both right-supporting and evil-dispelling. In particular, this experienced physician must have a firm command of this principle: for cancer patients the administration of supplementing medicinals must be used prudently and not for long durations, and large doses of heat-clearing medicinals must be included to counterbalance these great heat yang-supplementing medicinals. The paper first introduces the integrative Chinese and Western medicine therapeutic approach for thyroid tumors, and then uses a medical case of a patient Dr. Lee Chen-yu had treated at his Yu Sheng Chinese Medicine Clinic as material for conducting pattern identification as the basis of treatment. Dr. Lee Chen-yu has over 40 years of clinical experience along with accumulating extensive research experience and has been issued numerous therapeutic-related patents. From the medical case reviewed in this paper, it can be seen that Chinese medicine medicinal intervention provided effective results in the treatment postsurgical complications involving aphasia caused by recurrent laryngeal nerve edema following surgical resection for thyroid cancer. Additionally, it was evident that Chinese medicine medicinal treatment also suppressed the activation of cancer stem cells and significantly delayed the onset of recurrence and metastasis. These results certainly provide ample justification for further examination and research into the therapeutic concepts involved with integrative Chinese and Western medicine.