CAJ | 학술논문

目的：探讨 AT 方案配合龙血竭治疗乳腺癌放疗后局部复发溃烂的临床疗效。方法选取郑州市第三人民医院乳腺科近3年来住院接受治疗的明确诊断为乳腺浸润性导管癌化放疗后局部复发、皮肤溃烂患者11例。采用 AT 方案全身静脉化疗，21 d 为1个周期，共化疗2个周期；局部创面用生理盐水清洗，龙血竭片适量研碎呈细粉末状，均匀铺撒于创面，薄层纱布覆盖，1次/ d，直到创面愈合。结果入选11例患者中，局部溃烂面、癌结节完全消失6例（54.5%）；局部溃烂基本消失、癌结节大部分消失，彩超及 CT 检查同侧腋窝淋巴结明显缩小3例（27.3%）；局部溃烂有改善，癌结节、对侧乳腺肿块缩小，腋下、锁骨上下淋巴结缩小不明显2例（18.2%），治疗总有效率为81.8%（9/11）。AT 联合方案化疗的主要不良反应为血液系统毒性、脱发，其中Ⅲ、Ⅳ度中性粒细胞减少症发生率为54.5%（6/11），1例患者因Ⅳ度白细胞减少性发热而住院治疗；1例白细胞在正常范围，化疗间歇期持续低热37.5 ℃ 左右；90.9%（10/11）的患者发生不同程度的脱发；恶心/呕吐63.6%（7/11）；口腔黏膜炎27.3%（3/11）。无严重败血症事件，无因不良反应而死亡的病例。结论 AT 方案配合龙血竭治疗乳腺癌放疗后局部复发溃烂的临床疗效肯定，能明显减轻患者痛苦，提高生活质量，患者依从性好。
목적：탐토 AT 방안배합룡혈갈치료유선암방료후국부복발궤란적림상료효。방법선취정주시제삼인민의원유선과근3년래주원접수치료적명학진단위유선침윤성도관암화방료후국부복발、피부궤란환자11례。채용 AT 방안전신정맥화료，21 d 위1개주기，공화료2개주기；국부창면용생리염수청세，룡혈갈편괄량연쇄정세분말상，균균포살우창면，박층사포복개，1차/ d，직도창면유합。결과입선11례환자중，국부궤란면、암결절완전소실6례（54.5%）；국부궤란기본소실、암결절대부분소실，채초급 CT 검사동측액와림파결명현축소3례（27.3%）；국부궤란유개선，암결절、대측유선종괴축소，액하、쇄골상하림파결축소불명현2례（18.2%），치료총유효솔위81.8%（9/11）。AT 연합방안화료적주요불량반응위혈액계통독성、탈발，기중Ⅲ、Ⅳ도중성립세포감소증발생솔위54.5%（6/11），1례환자인Ⅳ도백세포감소성발열이주원치료；1례백세포재정상범위，화료간헐기지속저열37.5 ℃ 좌우；90.9%（10/11）적환자발생불동정도적탈발；악심/구토63.6%（7/11）；구강점막염27.3%（3/11）。무엄중패혈증사건，무인불량반응이사망적병례。결론 AT 방안배합룡혈갈치료유선암방료후국부복발궤란적림상료효긍정，능명현감경환자통고，제고생활질량，환자의종성호。
Objective To investigate the clinical effects of AT scheme combined with Chinese patent medicine Longxiejie tablets on local recurrence of ulceration after radiotherapy for breast cancer. Methods Eleven patients with local recurrence of ulceration after radiotherapy for invasive ductal carci-noma and accepted treatment in the past three years in the third people’s hospital of Zhengzhou were se-lected. Using AT scheme,they were treated with intravenous chemotherapy for 2 cycles,21 days for each cycle;The local wounds were cleaned with physiological salt water,proper amount of Longxiejie tablets was ground into a fine powder and the powder was spread on the wounds evenly,and cover the wounds with thin gauze once every day,till the wounds healed. Results The clinical curative effect:among the 11 cases,partially ulcerated surface and cancer nodules disappeared completely in 6 cases(54. 5% );lo-cal ulceration disappeared basicly,most of the cancer nodules disappeared obviously,color Doppler ultra-sound and CT examination showed that the axillary lymph nodes of the same sides reduced significantly in 3 cases(27. 3% );the local ulceration have improved a little,contralateral breast lumps,axillary gland, supraclavicular lymph mode had no significant change in 2 cases(18. 2% ),the total efficiency of curation was 81. 8%(9 / 11). The toxicity and side effects of the rescue chemotherapy:the main toxicity and side effects of the AT joint scheme were hematological toxicity and alopecia,of all,the occurrence of neutro-philic granulocytopenia of grade Ⅲ and Ⅳ was 54. 5%(6 / 11),1 patient was in hospital because of the fever due to the reduction of the white blood cells of grade Ⅳ;1 patient’s white blood cells was in the normal range,her body temperature remained 37. 5 ℃ or so in the intermittent of chemotherapy;90. 9%(10 / 11)of the patients were with different degrees of alopecia;Nausea or vomiting was 63. 6%(7 / 11);Oral mucositis was 27. 3%(3 / 11). No severe septicemia happened and nobody died from toxicity and side effects. Conclusions AT scheme combined with Longxiejie tablets is secure and effective for patients with local recurrence of ulceration after radiotherapy for breast cancer. It can significantly reduce the suffering of patients and improve the quality of patients’life,and compliance of the patients is good.