张桂琼 高力英 韩鹏炳 冉俊涛 张小钰 董艳琴 董方 李瑾

[摘要] 目的 观察中药方剂“兰州方加味”防治涎腺放射性损伤的临床疗效。 方法 选择2013年10月～2014年10月在甘肃省肿瘤医院放疗科初诊并接受调强放射治疗的头颈部恶性肿瘤患者22例，将其分为中药组（10例）和西药组（12例），均行调强放射治疗，中药组在放疗基础上配合口服中药“兰州方加味”，西药组放疗配合静脉输注还原型谷胱甘肽钠。放疗结束时，采用美国放射治疗肿瘤学组（RTOG）急性放射反应评价标准对两组患者涎腺損伤程度（口干、唾液黏稠度、味觉改变等临床症状）进行评价。 结果 两组患者涎腺损伤程度：中药组0、1、2级涎腺损伤分别为30%（3/10）、60%（6/10）、10%（1/10），西药组0、1、2级涎腺损伤分别为8%（1/12）、42%（5/12）、50%（6/12），两组患者均未出现3～4级涎腺损伤。中药组涎腺损伤程度明显低于西药组，差异有统计学意义（P < 0.05）。 结论 中药方剂“兰州方加味”可减轻头颈部恶性肿瘤患者放射性涎腺损伤程度，疗效优于还原型谷胱甘肽钠。

[关键词] 头颈部恶性肿瘤；调强放疗；涎腺放射性损伤；中医药治疗；兰州方

[中图分类号] R730.55 [文献标识码] A [文章编号] 1673-7210（2016）03（a）-0091-05

Clinical observation of supplemented Lanzhou Decoction in prevention and treatment of radiation-induced salivary gland damage

ZHANG Guiqiong1 GAO Liying2 HAN Pengbing2 RAN Juntao2 ZHANG Xiaoyu2 DONG Yanqin2 DONG Fang2 LI Jin2

1.Department of Integrated TCM & Western Medicine， Gansu Provincial Cancer Hospital， Gansu Province， Lanzhou 730050， China； 2.Department of Radiation Oncology， Gansu Provincial Cancer Hospital， Gansu Province， Lanzhou 730050， China

[Abstract] Objective To observe the clinical effects of supplemented Lanzhou Decoction in prevention and treatment of radiation-induced salivary gland damage. Methods Twenty two patients with head and neck malignant tumors who were first diagnosed and accepted the intensity-modulated radiotherapy in the Department of Radiation Oncology of Gansu Provincial Cancer Hospital from October 2013 to October 2014 were chosen. All cases were randomly divided into traditional Chinese medicine group （10 cases） and Western medicine group （12 cases）. All patients were given intensity-modulated radiation therapy. The patients in the traditional Chinese medicine group were combined the supplemented Lanzhou Decoction and radiotherapy， the others in the Western medicine group were applied the reduced glutathione sodium after the application of radiation. The damage degree of salivary glands （clinical symptoms such as dry mouth， saliva viscosity， taste change） of all patients was graded according to the acute radiation reaction criteria of radiation therapy oncology group （RTOG） at the end of treatment with intensity-modulated radiation therapy. Results The rates of 0， 1， 2 levels of salivary glands damage degree in traditional Chinese medicine group were 30% （3/10）， 60% （6/10）， 10% （1/10）. In Western medicine group， the rates of 0， 1， 2 levels were 8% （1/12）， 42% （5/12）， 50% （6/12）. The 3， 4 levels of salivary glands damage degree in two groups did not occur. The salivary gland damage degree of patients in the traditional Chinese medicine group was obviously lower than that of patients in the Western medicine group， there were significant differences between the two groups （P < 0.05）. Conclusion The supplemented Lanzhou Decoction can relieve the radiation-induced salivary gland damage of patients with head and neck cancer， the curative effect is better than that of the reduced glutathione sodium.

[Key words] Head and neck cancer； Intensity-modulated radiation therapy； Radiation-induced salivary gland damage； Traditional Chinese medicine treatment； Lanzhou Decoction

放射治疗是头颈部恶性肿瘤的主要治疗方法之一[1]，其对肿瘤的局部控制、提高患者的无瘤生存率及总生存率均具有较好的临床疗效。但涎腺位于头颈部，大多包含在放疗靶区内，由于涎腺是对放射线高度敏感的器官，故放射线在杀伤恶性肿瘤细胞时，与其邻近的涎腺组织也会受到损伤，导致涎腺分泌减少、口干、吞咽疼痛、味觉降低等系列并发症，这些并发症严重影响此类放疗患者的生活质量，部分患者无法坚持正常的放疗疗程，需延长治疗的时间，甚至可能会终止治疗方案。……