李梦萍 叶小卫 林炜濠

【摘要】 目的 觀察前列地尔治疗肿瘤患者下肢不对称性水肿的临床疗效。方法 21例下肢不对称水肿的肿瘤患者， 随机分对照组（9例）和研究组（12例）。对照组根据病因常规给予抗肿瘤、利尿、抗凝、改善淋巴回流障碍等内科用药手段治疗， 研究组在对照组基础上加用前列地尔治疗。对比两组患者的临床效果， 有效、显效以及痊愈患者症状改善时间。结果 研究组中治疗6例痊愈， 3例显效， 2例有效， 1例无效， 总有效率为91.67%;对照组治疗1例痊愈， 1例显效， 2例有效， 5例无效， 总有效率为44.44%。研究组总有效率高于对照组， 差异有统计学意义（P<0.05）。研究组有效、显效及痊愈患者症状改善时间为（1.0±0.2）d， 对照组有效、显效及痊愈患者症状改善时间为（3.0±1.0）d;研究组有效、显效及痊愈患者症状改善时间明显短于对照组， 差异有统计学意义（P<0.05）。结论 前列地尔治疗肿瘤患者下肢不对称性水肿效果明显， 值得临床推广， 但仍需大样本量观察统计。

【关键词】 前列地尔;肿瘤;下肢水肿

DOI：10.14163/j.cnki.11-5547/r.2019.33.047

Observation of the curative effect of alprostadil on asymmetrical edema of lower limbs in tumor patients   LI Meng-ping， YE Xiao-wei， LIN Wei-hao， et al. Guangzhou Hospital of Traditional Chinese Medicine， Guangzhou 510130， China

【Abstract】 Objective   To observe the clinical efficacy of alprostadil on asymmetrical edema of lower limbs in tumor patients. Methods   A total of 21 tumor patients with asymmetrical edema of lower limbs were randomly divided into control group （9 cases） and research group （12 cases）. The control group was treated by medical treatment methods of anti tumor， diuresis， anticoagulation， improvement of lymphatic reflux， and the research group was treated by alprostadil injection on the basis of the control group. The clinical effect and the time required for symptoms improvement in effective， effective and cured patients was compared between the two groups. Results   In research group， there were 6 cured cases， 3 excellent cases， 2 effective cases and 1 ineffective case， with total effective rate as 91.67%. In control group， there were 1 cured case， 1 excellent case， 2 effective cases and 5 ineffective cases， with total effective rate as 44.44%. The total effective rate in the research group was higher than that in the control group， and the difference was statistically significant （P<0.05）. Patients in the research group who were effective， effective， and cured had symptoms improvement time as （1.0±0.2） d， which was （3.0±1.0） d in the control group. The  symptoms improvement time in patients who were effective， effective， and cured in the research group was obviously shorter than that in the control group， and the difference was statistically significant （P<0.05）. Conclusion   Alprostadil shows obvious effect on the treatment of asymmetric edema of lower limbs in tumor patients， which is worthy of clinical promotion， but it still needs large sample for observation and statistics.

【Key words】 Alprostadil; Tumor; Edema of lower limbs

肿瘤患者出现下肢水肿的临床症状十分常见， 究其病理改变是由于下肢组织间隙内过多液体积聚于局部， 使得组织肿胀所致[1]。其中心性、肾性、肝性、营养不良性以及药源性多为双下肢对称水肿， 一般通过原发病的治疗可见效。血管及淋巴性原因所致的下肢水肿多为不对称水肿， 统称为脉管源性水肿。其中包括静脉曲张、静脉瓣功能不全、血管炎症、血管内血栓的形成以及脉管受压等因素均可使脉管运行障碍。王哲等[2]通过对357例住院患者单侧下肢肿胀的病因进行分析， 发现最常见的原因为下肢深静脉血栓形成， 其余病因包括感染、血肿形成、淋巴回流障碍、髂静脉压迫综合征、盆腔肿瘤压迫、动静脉瘘等。而这种不对称水肿， 西医临床上单纯使用利尿、抗凝、改善淋巴回流障碍等手段治疗， 疗效欠佳， 部分患者通过手术治疗效果较保守治疗提高， 但肿瘤患者较易失去手术机会， 中医则通过内服加外治方法治疗[3]。……