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肝內膽管癌之中醫會診病例報告

Chinese Medicine Consultation of Intrahepatic Cholangiocarcinoma: A Case Report

摘要


本病例患者為62歲女性,約2019年11月開始自覺右上腹痛,並於2020年10月發現小便顏色深,茶色,無小便疼痛,西醫診斷為肝內膽管癌(Intrahepatic cholangiocarcinoma)。2020年12月底接受化療,患者希望會診中醫減緩副作用。中醫診斷為肝鬱血瘀。故採用疏肝解鬱,活血化瘀之法治療,以四逆散加膈下逐瘀湯加減處方。追蹤半年餘,患者持續門診追蹤及化療住院會診中醫,病況維持,生活可自理。經由此病例探討肝內膽管癌的西醫診斷與治療,並論述膈下逐瘀湯在《醫林改錯》的記載與現代文獻應用。

並列摘要


The patient in this case is a 62-year-old female who began to consciously experience upper right abdominal pain around November 2019. In October 2020, the urine was dark and brown, and there was no pain when urinating. Western medicine was diagnosed as intrahepatic cholangiocarcinoma. Chemotherapy in late December 2020, and she hoped to consult Traditional Chinese Medicine to reduce her side effects. TCM diagnosis was liver Qi stagnation and blood stasis, so the method of treatment relieved the liver Qi stagnation, and promoting blood circulation. The prescription of treatment was Sini Powder and Gexia Zhuyu Decoction. After more than half a year, her condition was maintained, and her life could be taken care of by herself. Through this case studied the diagnosis and treatment of intrahepatic cholangiocarcinoma, and discussed the literature of Gexia Zhuyu Decoction.

參考文獻


Juan C Mejia, Jennifer Pasko: Primary Liver Cancers: Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma. Surgical Clinics of North America. 2020 Jun; 100(3): 535-549.
Ramy El-Diwany, Timothy M Pawlik, Aslam Ejaz: Intrahepatic Cholangiocarcinoma. Surgical Clinics of North America. 2019 Oct; 28(4): 587-599.
Sumera Rizvi, Gregory J Gores: Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013 Dec; 145(6): 1215-29.
雷浩然、周嘉揚、夏振源、金光亮:肝臟的第二種原發性癌症-肝內膽管癌。臨床醫學月刊 2017/03/31,79 卷 3 期,P134-140。
李欣樺、陳曉瑱、廖厚勳:以治療膽管癌患者吞嚥困難合併食慾不振案例體現金匱要略之肝脾病理關係-吞嚥困難合併食慾不振治療概念之探討。中醫藥研究論叢 2019/03,22 卷 1 期,177-185。

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