The Study Of Treatment With Traditional Chinese Medicine For Patients With Malignant Obstructive Jaundice Before And After PTCD Operation

In clinical, there are some patients with malignant obstructive jaundice who are elderly, or obstructed with long course of high bilirubin, or combined with other risk factors for operation timely, or have malignant tumor has lost its operation significance. The patients often have to choose to drain to reduce the serum bilirubin, by temporary or permanent drainage of bile with internal or external, breaking the vicious circle effectively and restoring the physiological cycle effectively. As a result of the long obstructive jaundice and cholestasis, the cell of liver lost its ability to intake and excrete the bilirubin, and the structure and function of intrahepatic microscopic bile duct have been damaged. Even though these patients are drained to reduce the serum bilirubin, there have a long time to restore the hepatic function of detoxification, excretion, synthesis of coagulation factors and serum albumin. So far, there are few reports in the literature of these postoperative patients of drainage treated with comprehensive treatment, or Traditional Chinese Medicine.ObjectiveThrough retrospective clinical study design, to study of the treatment by TCM in the postoperative drainage of patients with malignant obstructive jaundice, and sum up the thinking of treatment of this disease by TCM.MethodThe Study retrospectively collected 196 patients who were diagnosed as malignant obstructive jaundice hospitalized in the Surgery Department of Hepatobiliary and Pancreatic and the Department of Intervention in Guangdong Province Traditional Chinese Medical Hospital from 2010 September to 2014 September. And there were 64 cases after PTCD ultimately meet the inclusion of the qualified. The observation period is stipulated:the first visited was the day of admission, the second visited was one day within 3 days after the PTCD operation; the third visited was the 5-7 day after the PTCD operation. Using of clinical investigation table, Excel software to input the patient’s clinical data, including clinical diagnosis and treatment, searching the drug-using regularity and the differentiation of the patients by SPSS 17.0 software. The Main outcome measures:(1). The general information:including age, gender, weight, occupation, living habits, medical history, family history, allergic history and course of disease; (2).The clinical indicators: a. Clinical symptoms:skin stained yellow, abdominal pain, anorexia, nausea, weakness; b. Index of laboratory:TBil, DBi、 ALT、AST、PT、γ-GGT; c. Daily drainage volume of bile. (3).The syndrome indices:the four diagnostic information and the syndrome differentiation of TCM; (4).The application of indicators include all medicine or drugs during observation.Results1. The discomfort symptoms in preoperative and postoperative patients with malignant obstructive jaundice of PTCD.At first visited 64 patients, according to the statistics, found that their jaundice (51,79.7%), yellow urine (43,67.2%) are in the majority, followedby fatigue(39,60.9%),abdominal pain(33, 51.6%), anorexia(27, 42.2%),xerostomia(27, 42.2%), sleepless(21,32.8%), bitter(16, 25%), constipation(14, 2L 9%), abdominal distension(10,15.6%).In,the observation group after PTCD, their mainly discomfort symptoms were still being jaundice, yellow urine, xerostomia, but their incidence decreased compared with the preoperative. With adding the auxiliary treatment of traditional Chinese medicine, the patients with jaundice and yellow urine discomfort symptoms were frequency significantly less than before. Compared with the second visited, the symptoms of fever, fatigue, anorexia, abdominal distension were increased.2. The analysis of the syndromes about tongue and pulse in preoperative and postoperative patients with malignant obstructive jaundice of PTCD.In first visited patients, the maximum frequency of 64 cases of tongue coating in both groups was red tongue and moss yellow greasy(29 cases), dark tongue and moss yellow greasy(14 cases), pink tongue and moss white greasy(6 cases), pink tongue with moss thin white (2 cases), light dark and moss white greasy tongue(2 cases), etc. The frequency of pulse condition were the most slippery and fast(22 cases), fast (12 cases), slippery (11 cases), string, slippery and fast(8 cases), string and slippery(3 cases), string and fast(2 cases), fine and astringent(2 cases), string and astringent (2 cases), etc.3. Differentiation regularity of syndromes in patients with malignant obstructive jaundice of PTCD.In the first visited patients, a total of 17 kinds of statistics syndrome, where the top five were the Dampness-Heat Block Syndrome, Gan-Dan Damp-Heat Syndrome, Dampness-Blood Stasis Syndrome, Spleen-Deficiency and Wet-Accumulation Syndrome, Damp Obstructing in Middle-JIAO. The overall differentiation into the type of cases in accordance with Zang-Fu organs, the five pathogens and other factors category, which appears Dampness-Stasis Syndrome with 61 times, Heat-Accumulation Syndrome with 48 times, Blood-Stasis Syndrome with 42 times, Spleen-Deficiency Syndrome with 25 times, Gan-Stagnation Syndrome with 21 times, Qi-Deficiency Syndrome with 12 times, Yin-Deficiency Syndrome with 11 times, Yang-Deficiency Syndrome with 9 times, Phlegm-Accumulation Syndrome with 6 times, Cold-Stagnation Syndrome with 2 times and Sthenic-Fu Syndrome with 1 time.In the first visited patients, the most common syndromes were the Dampness-Heat Block Syndrome, Gan-Dan Damp-Heat Syndrome, Dampness-Blood Stasis Syndrome, Spleen Deficiency and Wet Accumulation Syndrome, Damp Obstructing in Middle-JIAO. After the PTCD, the maximum frequency of syndromes were Dampness-Heat Block Syndrome, Yin-Deficiency-Inner heat Syndrome, Liver-stagnation and Spleen-deficiency Syndrome, Interior Accumulation of Dampness and Turbid Syndrome, Stagnation Syndrome of Cold-Dampness in middle energizer, Spleen Deficiency and Wet Accumulation Syndrome. Accompanied with pathogen of Blood-stasis, phlegm and stasis mutual obstruction syndrome.4. The feature usage of Traditional Chinese medicine for patients with malignant obstructive jaundice of PTCD.The patients were undertaken Chinese Traditional Medicine postoperative of PTCD, and the pesticide applying dialectical was 104 times, an average of 2.4 times per person. There were 121 kind of Chinese herbal medicine used frequency of 1101 times, average 10.6 per prescription medication. All Chinese medicine classifies the effect according to the classification analysis, using the frequency of the top ten chinese medicine were tonify, and Qi-Regulating, etc. The use of single frequency and percentage of the top 20 drugs were Baked licorice, Capillary wormwood herb, Poria cocos, Bupleuri, Prepared pinellia tuber, White peony root, Atractylodes macrocephala koidz, Codonopsis lanceolata, Rhubarb, Ginger, Tangerine peel, Baikal skullcap root, Citrus aurantium, Jujube, Astragalus, Magnolia officinalis, Atractylodis rhizoma, Salvia, Dried ginger, Coptidis chinensis.Conclusion1. The distribution of basic TCM syndromes:the pathogen of Dampness, Heat, Blood were existed the whole course of the disease; the Pathogenesis of malignant obstruction jaundice is caused by multi pathogen; the Damp and Heat pathogen accumulated the body be a long time, the wet not only could change to the Heat, but also to the Cold, even accompanied with pathogen of Blood-stasis, phlegm and stasis mutual obstruction. The deficiency and excess as the main contradiction were transformed gradually in the course of the disease.2. The treatment of TCM can reduced the serum total bilirubin and direct bilirubin level, etc. and play a positive role in the treatment of those patients and its efficacy remains to be confirmed by further studies.3. After the PTCD, it mainly used traditional Chinese medicine based on Deficiency-nourishing drugs, and Qi-Regulating drugs, Eliminating jaundice drugs, etc. The frequency of application in single traditional Chinese medicine were dominated by Baked licorice, Capillary wormwood herb, Poria cocos, Bupleuri, Prepared pinellia tuber, White peony root, Atractylodes macrocephala koidz, Codonopsis lanceolata, Rhubarb, Ginger, Tangerine peel, Baikal skullcap root, Citrus aurantium, Jujube, Astragalus, Magnolia officinalis, Atractylodis rhizoma, Salvia, Dried ginger, Coptidis chinensis.