| Objective:Discussion on postoperative thyroid cancer TCM syndrome type distribution rule and the characteristic, so as to provide guidance for determining the treatment based on differentiation of symptoms and signs; evaluation of thyroid cancer after curative effect of Chinese medicine, looking for rich means of treatment.Methods:according to the diagnostic criteria of traditional Chinese medicine and Western medicine in differentiated thyroid cancer, cases of oral medicine were collected in postoperative patients with differentiated thyroid carcinoma, the patients with TCM diagnosis standard into yin deficiency, spleen kidney yang deficiency, qi stagnation, phlegm and blood stasis type four, and set inclusion and rejection criteria, according to the standard screening of 55 eligible case, collect general information and medical history of patients, including disease duration, surgical methods, pathological type, 131 I clear a detection of thyroglobulin (Tg), free three triiodothyronine (FT3), free thyroxine (FT4), Gao Min (sTSH), thyroid stimulating hormone thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb) etc.. Analysis of the above observation indexes and TCM syndrome type of correlation and to evaluate in the routine treatment of Western medicine, combined with syndrome differentiation of traditional Chinese medicine treatment efficacy. Based on analysis of characteristics of Professor Chen therapy for differentiated thyroid carcinoma postoperative medication.Results:(1) 55 cases of differentiated thyroid cancer patients,20 cases of male,36%, female 35 cases, accounting for 64%, the proportion of male and female was 4:7. Qi Yin deficiency syndrome was the most, accounting for 40% of the two. The average age of Yang deficiency of spleen and kidney, stagnation of liver Qi type average age minimum. There was no significant difference in the sex and age distribution between different TCM syndromes (P>0.05).(2) differentiated thyroid cancer with TCM syndrome differentiation is Qi and yin deficiency syndrome patients, in the postoperative course of less than or equal to six months is the most common; spleen kidney yang deficiency patients in the postoperative course is more than or equal to 2 years the most common; patients with liver qi stagnation syndrome in the postoperative course of 0.5-1 years the most common; 1-2 years after operation in patients of phlegm and blood stasis. The most common TCM syndrome type distribution in different course of disease group was not significant difference (P>0.05).(3) four TCM syndrome types of phlegm and blood stasis syndrome, the average value of the size of the lesion is the largest, and the average value of the lesion size of Qi Yin deficiency is the smallest in the two. But there was no statistical difference between TCM Syndrome Types and lesion size (P>0.05). Syndrome of deficiency of both qi and Yin solitary lesions and other syndromes have significant difference (P< 0.05).(4) in 29 patients with lymph node metastasis, two of the patients with Qi Yin deficiency syndrome had the most, accounting for 52%. In 26 patients without lymph node metastasis, phlegm and blood stasis syndrome was the least, accounting for 12% of the patients. There was no significant difference in lymph node metastasis between different TCM syndromes (P> 0.05).(5) clinical observation of 55 cases of differentiated thyroid cancer patients, the proportion of papillary thyroid carcinoma was 93%. The proportion of follicular thyroid carcinoma was 7%. The proportion of the two is 12.75:1.51 cases of papillary thyroid carcinoma, Qi and yin deficiency accounted for 41%. There was no statistical difference in TCM syndrome types of different pathological types (P> 0.05).(6) surgical approach for total or near total thyroidectomy with Yang deficiency of spleen and kidney most proportion 44%; surgical thyroid lobe plus isthmic resection with deficiency of both qi and Yin, the proportion of 43%. There was no statistical difference between the different types of TCM syndromes (P> 0.05).(7) of 51 cases of TG is less than or equal to 55ng/ml in patients with Qi and yin deficiency syndrome most, accounted for 41%; 4 cases Tg>55ng/ml patients, Yang deficiency of spleen and kidney the most, which accounts for 50% of the proportion of. There was no significant difference in the range of Tg value between TCM syndromes (P> 0.05).(8) differentiated thyroid cancer after operation the thyroid function FT3, FT4 were compared of Yang deficiency of spleen and kidney below the other three groups, but there was no statistical difference (P> 0.05), spleen kidney yang deficiency of thyroid stimulating hormone (TSH) were higher than those of the other three groups, the difference has statistical significance (P< 0.05).(9) of 24 cases of TPOAb positive patients, phlegm and blood stasis syndrome at least, accounting for 28.6%, Yang deficiency of spleen and kidney most accounted for 66.7%, positive rate of TPOAb of spleen kidney yang deficiency type high stagnation of liver qi stagnation syndrome, phlegm and blood stasis in the two groups, the difference is statistically significant (P< 0.05).(10) in 7 patients with phlegm and blood stasis, the number of high-risk group most accounted for 57%,11 cases of stagnation of liver qi stagnation syndrome, the number of low-risk group at least, accounted for 55%. There was no statistical difference (P>0,05) in different risk stratification between different TCM syndrome types.(11) of TCM symptom score comparison, Qi and yin deficiency, spleen kidney yang deficiency, stagnation of liver qi stagnation syndrome before and after treatment integral is decreased, the significant statistical difference (P< 0.01), phlegm and blood stasis treatment after integral is decreased, but the differences without statistical significance (P>0.05).Qi and yin deficiency of total efficiency is 91%, the spleen kidney yang deficiency syndrome, total efficiency is 80%, the stagnation of liver qi stagnation syndrome total efficiency is 82%, Phlegm Blood Stasis total efficiency is 71%. The Qi and yin deficiency syndrome in two oliguresis, dry stool improvement is the best proportion and percentage improvement for 79%; Yang deficiency of spleen and kidney in sweat, urine clear improvement ratio is better, respectively 73%,71%; liver qi stagnation syndrome in hypochondriac pain, belching improvement ratio is better, which were 89% and 80%; phlegm and blood stasis in partial body sweating, anterior cervical pain improvement ratio is better, were 77% and 75%. Among the four types of syndromes, the best proportion of the symptoms was insomnia, edema and hair loss, and the improvement rate was 25%,33%,33%, respectively. Qi and yin deficiency syndrome before and after treatment two groups comparison of FT3, FT4 increased, decreased TSH, TG after treatment than before treatment decreased, with significant difference (P< 0.05); spleen kidney yang deficiency syndrome before and after treatment two groups comparison of FT3, FT4 increased, decreased TSH, with significant difference (P< 0.05). TG before and after treatment decreased, but there was no statistical significance (P> 0.05); stagnation of liver qi stagnation syndrome before and after treatment two groups comparison of FT3, FT4 increased, decreased TSH, compared with those before treatment fell TG after treatment, with significant difference (P< 0.05); phlegm and blood stasis treatment of two groups before and after the comparison of FT4 are increased, decreased TSH, with significant difference (P< 0.05), FT3 after treatment than before increased, TG after treatment than before treatment decreased, but no significant difference (P> 0.05).Respectively:There is close relationship between conclusion: differentiated thyroid cancer after operation every syndrome type and patient sex, course of disease, surgical procedures, lesion size and number, pathological types, lymph node metastasis, thyroid function, TGAb, TPOAb, TG, postoperative recurrence risk stratification; traditional Chinese medicine treatment of differentiated thyroid carcinoma after operation, the patients symptoms improved significantly, the Chinese medicine in the treatment of differentiated thyroid carcinoma after have vast space. |
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