糖尿病合并胆管癌关系探讨及病案分析一例.docVIP

糖尿病合併膽管癌關係探討及病案分析一例 林蓓茵，馮奕斌* （香港大學中醫藥學院，*通訊作者） 【摘要】本文從中西醫理論分析糖尿病合併膽管癌的成因和病機，並從一病案探討治療本病的原則和用藥思維。在補腎活血解毒的基礎上，分不同階段重用茵陳五苓散、三莪六君湯、葛根芩連湯，以達利膽退黃、抗癌、控制血糖之效。近三年多的調理治療，膽管癌症狀好轉，病情穩定,糖尿病也得到較好控製，停用胰島素，體現了馮奕斌博士臨牀辨證思維中綜合病證結合、五藏相關、整體調理、扶正祛邪等中醫學理論在現代複雜難性疾病中的應用實例。 【Abstract】It is aimed to analyze the factors and pathogenesis of diabetic patient combined with cholangiocarcinoma based on the theory of Chinese and Western medicine, and to explore its principle of treatment and relevant logic of prescribing Chinese medicine from a case study: Based on the principal of Bushen Huoxie Jiedu (strengthening kidney function, increasing blood circulation and detoxication), Chinese Medicine decotion such as Capillaris combined Wulingsan, San E Liujun decotion and Gegenqinlian decotion are used in different stages of the disease in order to Lidan Tuihuang (relieving jaundice by dredging gallbladder), anticancer and control blood sugar level. The diabetic patient combined with cholangiocarcinoma in this case has been coming to a stable condition with cholangiocarcinoma?s symptoms relieved, blood sugar level controlled without insulin injection, after three-year Chinese medicine treatment from Dr. Yinbin Feng. It shows how Chinese medicine theory such as the combination of disease and syndrome, relationship of five organs, holistic view and Fuzheng Quxie method (strengthen the body to fight the disease) are applied to treat complicated diseases nowadays. 【關鍵詞】糖尿病膽管癌 膽管癌是一種膽管上皮細胞的惡性腫瘤，其發生率約佔消化道惡性腫瘤的3%[1]。流行病學資料表明，近30年來，膽管癌的發病率有明顯的上升趨勢[2]。膽管癌的發病機理尚不清楚，若能明確膽管癌的相關危險因素，有助於作出針對性的預防。目前，有研究發現，糖尿病是膽管癌的重要危險因素之一[3]。本文試從中西醫理論分析糖尿病合併膽管癌的機理，舉例分析香港大學中醫藥學院馮奕斌博士治療糖尿病合併膽管癌病案一例。 1 現代醫學對糖尿病合併膽管癌的研究 膽管癌惡性程度高，早期難以診斷，確診時往往已到中晚期，手術及放化療根治率低，預後差，五年生存率大約8%[4]。膽管癌病因目前尚未明確，根據過往大部份的流行病學研究表明，原發性硬化性膽管炎、膽石病、異常的膽管—胰管畸形、肝硬化、麝貓後睾吸蟲、二氧化釷等放射性物質、吸煙等均為膽管癌的高危因素[5]。近年有較多的研究結果提示，糖尿病是數種惡性腫瘤發病危險因素，如肝癌[6]、子宮內膜癌[7]和膽管癌等[8]。劉春興等[9]通過對7項關於糖尿病和膽管癌發病關係的Meta分析研究表明，糖尿病患者患膽管癌的發病風險增加59%，提示糖尿病可能也是膽管癌的致病危險因素，而且糖尿病病程的延長可使患膽管癌的風險增加。 Welzel[10]等進行大樣本的關於