标题：黄芪防己汤加减在喉癌术后放疗所致迟发性淋巴水肿中的应用

      作者：张心怡 1，杨静 2，张砚敏 3    1.陕西省中医医院耳鼻喉科，陕西 西安 710003；2.空军军医大学第二附属医院耳鼻咽喉头颈外科，陕西 西安 710038；3.陕西省中医医院检验科，陕西 西安 710038

      卷次： 2019年30卷24期

      【摘要】 目的 探讨黄芪防己汤加减在喉癌术后放疗所致迟发性淋巴水肿患者中的应用效果。方法 选择2016年8月至2018年8月在陕西省中医医院耳鼻喉科治疗的60例术后迟发性淋巴水肿患者作为研究对象。按照随机数表法分为观察组和对照组，每组30例。对照组患者采用常规调强放疗，观察组患者在对照组治疗的基础上加用黄芪防己汤加减，连续服用10周。比较两组患者治疗后的临床疗效、喉淋巴水肿LENT-SOMA评分、颈部淋巴水肿改良 Miller评分、欧洲癌症研究与治疗组织的生活质量核心量表(EORTCQLQ-C30)评分和不良反应发生率。结果 治疗后，观察组患者的治疗总有效率为93.33%，明显高于对照组的70.00%，差异有统计学意义(P<0.05)；治疗后，观察组患者的喉淋巴水肿 LENT-SOMA评分多在 0~1级，对照组多在 2~3级，观察组颈部淋巴水肿改良Miller评分多在0~1级，对照组多在2~3级，差异均有统计学意义(P<0.05)；治疗后，观察组患者的躯体功能、角色功能、情绪功能、认识功能、社会功能及总生活质量评分分别为(64.02±21.36)分、(50.61±12.23)分、(55.59±15.82)分、(67.18±10.92)分、(66.35±12.76)分、(64.29±16.21)分，明显高于对照组的(51.21±13.94)分、(42.63±12.02)分、(40.32±12.53)分、(59.12±9.83)分、(56.76±12.52)分、(53.48±14.29)分，差异均有统计学意义(P<0.05)；治疗后，观察组的不良反应总发生率为3.33%，明显低于对照组的30.00%，差异有统计学意义(P<0.05)。结论 黄芪防己汤加减在喉癌术后放疗所致迟发性淋巴水肿患者中的应用效果显著，其可有效改善患者淋巴水肿情况，且不良反应少，值得推广应用。
      【关键词】 喉癌；迟发性淋巴水肿；调强放疗；黄芪防己汤；放疗；效果
      【中图分类号】 R739.65 【文献标识码】 A 【文章编号】 1003—6350（2019）24—3184—04

Curative efficacy of Huangqi fangji Decoction on radiation-associated secondary lymphedema in laryngealcarcinoma patients.
ZHANG Xin-yi 1, YANG Jing 2, ZHANG Yan-min 3. 1.Department of Otolaryngology, ShaanxiProvincial Hospital of Traditional Chinese Medicine, Xi'an 710003; Shaanxi, CHINA; 2. Department of OtorhinolaryngologyHead and Neck Surgery, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, Shaanxi,CHINA; 3. Department of Laboratory, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710038, Shaanxi,CHINA
【Abstract】 Objective To explore the application of Huangqi Fangji Decoction in patients with delayed lymph-edema caused by radiotherapy after laryngeal cancer. Methods A total of 60 patients with delayed lymphedema causedby radiotherapy after laryngeal cancer treated in Department of Otolaryngology, Shaanxi Provincial Hospital of Tradi-tional Chinese Medicine from August 2016 to August 2018 were selected as research objects. According to random num-ber table method, the patients were divided into the observation group and control group, with 30 cases in each group.The patients in the control group received conventional intensity modulated radiation therapy (IMRT), and the patients inthe observation group were treated with Huangqi Fangji Decoction in addition to IMRT. The treatment course is 10weeks. The clinical efficacy, Late Effects on Normal Tissues/Subjective, Objective, Management, and Analytic (LENT/SOMA) scores, modified Miller score, European Organization for Research and Treatment of Cancer (EORTC) Qualityof Life Questionnaire QLQ-C30 (EORTC QLQ-C30) score and the incidence of adverse reactions were compared be-tween the two groups. Results After treatment, the total effective rate of the observation group was 93.33%, which wassignificantly higher than 70.00% of the control group (P<0.05); the LENT-SOMA score of laryngeal lymphedema wasmostly at grade 0-1 in the observation group and grade 2 to 3 in the control group, the modified Miller's score of cervicallymphedema in the observation group was mostly at grade 0-1, while that in the control group was mostly at grade 2-3,and the difference was statistically significant (P<0.05); the scores of physical function, role function, emotional func-tion, cognitive function, social function and total quality of life in the observation group were (64.02 ± 21.36) points,(50.61±12.23) points, (55.59±15.82) points, (67.18±10.92) points, (66.35±12.76) points, (64.29±16.21) points, respec-tively, which were significantly higher than corresponding (51.21±13.94), (42.63±12.02), (40.32±12.53) points, (59.12±9.83) points, (56.76±12.52) points, (53.48±14.29) points in the control group (all P<0.05); the total incidence of adverse