| Research backgroundAs the age structure of China’s population gradually tends to be aging,the incidence rate of cancer has increased significantly due to the change of living habits and diet structure,so the operation rate of malignant tumors has also increased.However,due to the complicated condition,long operation time and large operation scope of malignant tumor patients,the incidence of AIO(Adhesive intestinal obstruction,AIO)after surgery also increases year by year,which seriously affects the health of patients and is an urgent clinical problem.Currently,the treatment of AIO after malignant tumor surgery includes conservative treatment and surgical treatment.Since it is difficult for patients with AIO to undergo surgical treatment again and the probability of intestinal obstruction is increased,so conservative treatment is the first choice.Western medicine conservative treatment includes fasting of water,decompression of gastrointestinal tract,nutritional support,application of somatostatin drugs,and anti-infection when necessary,which has achieved certain curative effect.Literature studies have found that traditional Chinese medicine has a good effect on AIO.Traditional Chinese medicine treatment includes oral administration of traditional Chinese medicine and external treatment of traditional Chinese medicine.Since the patients with intestinal obstruction cannot eat normally,the application of traditional Chinese medicine decoction will increase the gastrointestinal burden of patients,and it has liver and kidney effects,therefore,external treatment of traditional Chinese medicine is more suitable for the treatment of AIO.TCM external treatment methods are various,including enema,external application,acupuncture and moxibustion.It has the advantages of simple operation,economic convenience,easy acceptance,good tolerance,small side effects,and repeated administration.During the clinical treatment,the tutor found that the syndrome differentiation of IAIO(incomplete adhesive intestinal obstruction,IAIO)patients after malignant tumor surgery was mostly "cold coagulation and qi stagnation".So she use the principles of"warming Yang and dispersing cold,promoting Qi and bowel-relaxing" with the application of "WenYangXingQiTongFu" to Shenque acupoint application with western medicine conservative treatment,cured many patients with" cold coagulation and qi stagnation " type adhesive intestinal obstruction,which is a single group clinical study and the effective rate was 88.9%.So this study adopts the randomized controlled method to observe the clinical effect of "Wenyang Xingqi Tongfu Decoction" Shenque acupoint application in the treatment of IAIO with cold coagulation qi stagnation type after malignant tumor operation,so as to evaluate the clinical efficacy and safety of this prescription more scientifically and provide clinical service.Research objectiveThrough the prospective randomized controlled clinical study,the clinical efficacy and safety of "Wenyang Xingqi Tongfu Decoction" Shenque acupoint application in the treatment of IAIO with cold coagulation and qi stagnation type after malignant tumor was evaluated,so as to provide scientific basis for TCM acupoint application in the treatment of IAIO after malignant tumor operation,what’s more,it will provide a more safe,effective and simple treatment scheme for such patients.Research methodsIn this study,a prospective,open,randomized,parallel controlled clinical design was used to collect 70 patients with IAIO from November 2017 to December 2020 both from in Beijing integrated traditional Chinese and Western medicine hospital and Cancer Hospital of Chinese Academy of Medical Sciences.According to the random method,the patients were divided into the control group and the treatment group.Both groups were given conventional Western medicine.The treatment group was added with "Wenyang Xingqi Tongfu Decoction"Shenque acupoint application.The recovery of intestinal function and TCM symptom scores were recorded before treatment and after 1,3,7,10 and 14 days of treatment.The orthostatic abdominal plain films were compared after 14 days of treatment,and the results were statistically analyzed,the efficacy and safety indexes were evaluated,and the patients were followed up after 1 month of treatment.Research results1.Comparison of overall efficacy:According to the statistical analysis of the results,in the treatment group,there were 35 cases,4 cases fell off,and 31 cases completed,18 cases of complete remission,7 cases of markedly effective,1 case of effective and 5 cases of ineffective,and the total effective rate was 83.8%;In the control group,there were 35 cases,3 cases fell off,and 32 cases completed,9 cases of complete remission,8 cases of markedly effective,5 cases of effective and 10 cases of ineffective,and the total effective rate was 68.7%.The difference of total effective rate was statistically significant(P=0.014,P<0.05).It indicates that the clinical effect of "Wenyang Xingqi Tongfu Decoction" combined with Acupoint Application in the treatment of AIO with cold coagulation and qi stagnation after malignant tumor operation is better than that of conventional western medicine alone.2.Comparison of TCM Syndrome:Through the statistical comparison of TCM symptom scores of the two groups before and after treatment,the results showed that:In the treatment group,there were 18 cases of complete remission,7 cases of markedly effective,3 cases of effective and 3 cases of ineffective,the total effective rate was 90.3%;In the control group,there were 9 cases of complete remission,8 cases of markedly effective,7 cases of effective and 8 cases of ineffective,the total effective rate was 75.0%.The difference of effective rate of TCM syndromes was statistically significant(P=0.010,P<0.05),It indicates that Wenyang Xingqi Tongfu Decoction" Shenque acupoint application has better effect on improving TCM symptoms of AIO patients.3.Comparison of Karnofsky score:According to the statistics of Karnofsky score of 63 patients,in both two groups,before and after treatment,the difference was statistically significant(P=0.00,P<0.01),but there was no statistically significant difference between the two groups(P=0.06,P>0.05),it shows that "Wenyang Xingqi Tongfu Decoction"Shenque acupoint application combined with western medicine conservative treatment or simple western medicine conservative treatment is helpful to improve the quality of life of patients,but there is no statistical difference between the two groups.4.Comparison of intestinal function recovery:There was no significant difference in the recovery of defecation,bowel sounds,gastric juice drainage and vomiting between the two groups(P>0.05),but there was significant difference in the recovery of exhaust between the two groups(P<0.01).5.Safety evaluation:During the whole process of the study,two patients in the treatment group had slight red skin after application,without special treatment.After 4 hours of observation,the red disappeared,without pruritus and blisters.Patients in the treatment group did not show abnormal blood routine,liver and kidney function,ion level and electrocardiogram,the results showed that "Wenyang Xingqi Tongfu Decoction" Shenque acupoint application was a safe and feasible treatment for IAIO patients with cold coagulation and qi stagnation after malignant tumor surgery.6.Follow-up:Follow up the patients after the treatment in 1 month and estimate the results:In the treatment group,among the 26 patients whose curative effect was evaluated as effective,1 patient had recurrence of obstruction,and the recurrence rate was 3.8%.The 5 patients who were invalid refused the operation because of their old age and continued to apply "Wenyang Xingqi Tongfu Decoction" at Shenque point for 1 month.The symptoms were relieved,but there were still different degrees of obstruction,which was related to the longer course of obstruction and the heavier degree of obstruction.In the control group,among the 22 patients whose curative effect was evaluated as effective,2 patient had recurrence of obstruction,and the recurrence rate was 9.1%,they were all caused by improper diet.The 10 patients who were ineffective were all transferred to surgical treatment.Research conclusion"Wenyang Xingqi Tongfu Fang" Shenque acupoint application can better improve the symptoms and signs of intestinal obstruction,situation of standing abdominal plain film.Especially in the improvement of abdominal pain,abdominal distension,abdominal cold,hiccup and belching symptoms,the treatment group is better than the control group,and it is safe and effective,with low recurrence rate.Therefore,it can be used as one of the effective methods for clinical treatment of IAIO cold coagulation and qi stagnation type after malignant tumor surgery. |
