中医药研究论丛

221.21 中西医治疗大肠癌合并缺铁性贫血之病例报告
TJ TCM.22(1) : 213-230, 2019
中西医治疗大肠癌合并缺铁性贫血之病例报告
Cancer Complicated with Iron Deficiency Anemia Treated with Traditional Chinese
Medicine: A Case Report
萧朝阳1 黄建荣1 戴有志1.2*
1 佛教慈济医疗财团法人台北慈济医院中医部,台北,台湾
2 慈济大学学士後中医学系,花莲,台湾
【摘要】
大肠直肠癌长年占据国内十大癌症死亡原因的前三位,2017 年卫生福利部统计大肠直肠癌死亡率为仅次於肺癌与肝癌。大肠直肠癌中升结肠的肿瘤相对降结肠的肿瘤而言,阻塞症状可较不明显,多以产生溃疡,间歇性出血,因而发生肉眼不易辨别的血便,而出现疲劳、心悸、心绞痛作为主要症状,暗示着缺铁性贫血的发生与加重。本篇病例报告报导一位53 岁已停经女性,有子宫肌瘤合并贫血病史,於2015 年7 月因为发烧与腹胀就诊,经血液肿瘤科诊察後再次诊断为缺铁性贫血,怀疑有肠胃道出血的可能。2015 年11月因渐进性腹胀与持续头晕而住院,经过系列检查後诊断为大肠癌第四期;除了安排手术、缓和性化疗处方与标靶治疗以外,同时开立铁剂予病人使用;但病人出现肠胃道副作用而不愿意继续服用铁剂,隔年2016 年1 月开始於本院中医门诊调治,中医诊断为虚劳、肠蕈,证型为肝肾阴虚,肝阳上亢,气血两虚,并有痰湿瘀浊下注,治则为平肝养阴,补益气血,健脾渗湿,化瘀。经过系列中药调理後,病人的疲倦等主观症状有明显改善,且贫血部分也由实验室检验确认回复至正常范围,病人得以持续接受西医化疗。我们希望藉由此个案说明中医药辅助治疗大肠癌合并之缺铁性贫血之疗效。
【关键词】大肠癌、缺铁性贫血、中西医药治疗
Chao-Yang Hsiao1 Chien-Jung Huang1 Yu-Chih Tai1,2*
1Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Taipei, Taiwan
2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
【Summary】
Colorectal cancer is the third lading cause of cancer death in Taiwan. There may be less obstructive symptoms in ascending colon tumors. Otherwise, ascending colon tumors usually produce ulcers that intermittently bleed, resulting occult blood loss. Other typical symptoms related to ascending colon tumors may be fatigue, palpitations, and angina. This case reports a 53 year old female with known history of menopause, uterine myoma and anemia, who came to clinic for fever and abdominal bloating sensation in July 2015. Iron deficiency anemia was diagnosed. Gastrointestinal origin blood loss was suspected. However, the patient was admitted to hospital in November 2015 due to progressive abdominal distension and persistent dizziness. After serial study, colorectal cancer, stage IV was diagnosed. Colorectal tumor resection and palliative chemotherapy, target therapy were arranged. Oral Iron supplement was prescribed. However, there was obvious GI upset after oral iron supplement so the patient stopped the treatment and seek for Traditional Chinese Medicine (TCM) therapy in January 2016. The patient had obvious fatigue sensation, dizziness, and persistent anemia despite colorectal tumor resection. The diagnosis according to TCM theory were liver and kidney yin deficiency, liver yang excess, blood and qi deficiency, phlegmdampness and blood stagnation and fall.The treatment principle were harmonizing the liver and spleen, liver yin supplement, blood and qi supplement, fortifying the spleen and disinhibiting dampness, and dispelling stasis. After serial Chinese medicine usage, the patient had fatigue and anemia improved so that the patient could tolerated the following chemotherapy regimen. We hope the case could be used to illustrate the efficacy of TCM therapy for colorectal cancer related iron deficiency anemia.
KeywordsColon cancer, Iron deficiency anemia, Traditional Chinese Medicine (TCM)