The Prognosis Of Patients With Digestive System Tumor-related Intestinal Obstruction And The Investigation Of The Advantages Of Combined TCM Treatment And The Study Of Syndromes And Factors

Objective:With the combination of literature study and retrospective research,this study investigated and analyzed the prognostic factors of patients with digestive system tumor-related intestinal obstruction and the drug characteristics of those who benefit from combined Chinese medicine treatment,and explore effective treatment measures;and record the clinical symptoms,explore the main disease location and disease syndrome of the patients according to the TCM syndrome,try to provide reference for the prevention of the occurrence and development of tumor-related intestinal obstruction and the scientification and objectification of treating tumor-related intestinal obstruction in combination with traditional Chinese medicine.Methods:Part I: Patients with intestinal obstruction caused by digestive system tumors in the oncology department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from October 2016 to October 2020 were collected according to the inclusion,exclusion and diagnostic criteria.The clinical evidence of the patients with complete data was collated,and the survival data of 152 dead cases were analyzed,Kaplan-Meier survival analysis was used for univariate analysis,log-rank test was used for survival rate comparison,and COX regression method was used for multivariate analysis to determine the prognostic factors.Then select the cases that benefit from combined traditional Chinese medicine treatment,summarize and describe their treatment methods and medication characteristics.Part II: Use the "Sydrome Differentiation Factor Table" proposed by Zhu Wenfeng to formulate a clinical questionnaire,collect the data of cases with complete TCM information,and use Chi-square or Fisher test to analyze the correlation between the main syndrome factors and some clinical indexes and prognostic factors.Results:1 Among the 2476 patients with digestive system tumors in this study,223 patients had a history of obstruction,with an incidence of about 9.01%.From highest to lowest,they were 19.33% for colon cancer,16.07% for small intestine cancer,9.56% for pancreatic cancer,8.36% for rectal cancer,8.34% for gastric cancer,8.13% for biliary cancer,3.26% for liver cancer and 2.42% for esophageal cancer.Patients with the lower digestive system tumors are more prone to intestinal obstruction.2 Among the 170 patients with intestinal obstruction caused by digestive system tumors who met the enrollment criteria,152 died and 18 patients survived,lost follow-up and refused to be interviewed.The average survival time was 5.643±0.492 months,and the median survival time was 3.7 months.Kaplan-Meier method single factor analysis results showed: KPS score,peritoneal metastasis,ascites,cachexia,degree of obstruction,albumin level,serum potassium,serum sodium,blood glucose,analgesics,integrated traditional Chinese and western medicine treatment after obstruction were related to the prognosis of the patients(P<0.05).Multivariate COX regression analysis showed that peritoneal metastasis,ascites and high blood glucose were independent risk factors for prognosis,and KPS score≥70 was an independent protective factor for prognosis.3 The TCM symptom scores of patients before and after combined TCM treatment were significantly improved(P<0.01△),and the overall remission rate was 72.07%;the KPS score was significantly improved before and after treatment(P<0.01△),and the total effective rate was 59.46%.4 The main treatment method of the group benefiting from the combination of Chinese medicine treatment is Chinese medicine enema,and the proportion of patients who are treated with oral orgastric tube injection decoction is nearly 1/3.According to the statistics and frequency analysis of prepared pieces of traditional Chinese medicine,the 25 drugs with higher frequency are mainly Qi-regulating drugs,Qi-tonifying drugs,Yin-nourishing drugs,dampness-relieving drugs,dampness-infiltrating drugs,blood-activating and stasis-activating drugs,and warming drugs.The five flavors of the medicine are mainly pungent,sweet and bitter,and the main meridians are spleen,stomach,lung,liver,kidney,heart,large intestine and so on.5 Syndrome factor analysis: the survey found that there are 10 types of syndrome elements that meet the requirements.The order of frequency statistical analysis from high to low is spleen(80.59%),stomach(64.12%),large intestine(38.24%),kidney(31.18%),small intestine(26.16%),lung(25.29%),liver(19.77%),heart(20.93%),gallbladder(7.56%),bladder(3.49%),mainly concentrated in spleen,stomach,large intestine and kidney.There are 13 kinds of disease syndrome elements that meet the requirements.The order of frequency statistical analysis from high to low is Qi deficiency(82.35%),Qi stagnation(77.65%),dampness(66.28%),Yang deficiency(47.09%),Yin deficiency(45.93%),blood stasis(32.94%),drinking stop(25.58%),phlegm(22.67%),blood deficiency(19.19%),heat(15.29%),closure(12.35%),cold(9.41%),food accumulation(8.72%),Poison(5.23%),mainly concentrated in syndrome elements such as Qi deficiency,Yin deficiency,Yang deficiency,Qi stagnation,dampness resistance,blood stasis and so on.In the combination of syndrome elements,below three syndrome elements account for8.24%,four syndrome elements account for 48.82%,five syndrome elements account for32.94%,and more than six syndrome elements account for 10.00%.There are 83 people in the combination of four syndrome elements,and there are 37 types of syndrome elements.The main types are Qi deficiency + Yin deficiency + Qi stagnation + dampness,Qi deficiency +Yang deficiency + Qi stagnation + dampness,Qi deficiency + blood deficiency + Qi stagnation + dampness,Qi deficiency + Yang deficiency + blood stasis + drinking cessation,Qi deficiency + Yin deficiency + Qi stagnation + blood stasis,Qi deficiency + Yin deficiency+ dampness + heat.6 Influencing factors among syndrome elements: spleen syndrome elements are prone to appear after operation,Yin deficiency and Yang deficiency syndrome elements are prone to appear after chemotherapy,and Yang deficiency syndrome elements are prone to appear after targeted treatment.Blood stasis factors is prone to appear after liver metastasis,and Qi deficiency and blood stasis factors are prone to occur after lung metastasis.Low albumin level is prone to Yang deficiency and stomach syndrome,while hypokalemia patients are prone to Qi deficiency syndrome.Patients with peritoneal effusion are prone to Yang deficiency,Qi deficiency and blood stasis syndrome,and those with high blood sugar are prone to Yin deficiency and Qi deficiency syndrome.Conclusion:1 The incidence of intestinal obstruction in patients with digestive system tumors is about 9.01%,of which the incidence of colon cancer of 19.33%.Most of the patients were over 60 years old,and most of them were in IV stage.2 The prognosis of patients with digestive system tumor-associated intestinal obstruction is poor,and peritoneal effusion,peritoneal metastasis and high blood glucose are independent risk factors.KPS≥70 is its independent prognostic protective factor.3 Combined treatment with traditional Chinese medicine does have advantages in the improvement of symptoms and prognosis,especially in patients who combine oral administration or gastric tube injection at the appropriate time.4 Combined with the disease location and disease syndrome factors,it is preliminarily explored that the deficiency and block of Zhongjiao is the key to the pathogenesis of digestive system tumor-related intestinal obstruction.