【关键词】 生存质量 中晚期胃癌 疗效 中医 中西医结合 西医
The therapeutic effect comparison of different methods to treatlate carcinoma by evaluation of patient life quality
【Abstract】 Objective To plait combination of TCM and western medicine QOL table and evaluation the effect of late phase carcinoma of stomach patient of QOL by this table.To plait the table to evaluation the effect of three methods antitumor by improving the QOL.
Methods (1)First time to plait the combination of TCM and western medicine.QOL table Basing on the literature of interal and extra country about the measuring scale，revising and consurnmating step by step，plait the table with the Chinese medical science peculiarity，(2)Applying the table firstly comparised the effect of various kinds methods improving the patient’s QOL.The 478 patients was choosed，among them 204 patients were offered by chemotherapy.110 atients was offered combination of TCM and western medicine.114 patients offered the traditional Chinese medicine.All the patients filled in a form at pretreatment and post-treatment partly，based on the difference of QOL between the pretreatment and post-treatment，assembling analysing.Comparising the effect of various kinds methods rising stomach cancer QOL.Results (1)Statistics check’s rudiment result makes clear that the table can be applied in clinical.(2)The traditional Chinese medicine’s population effect is the best，improving rate is the highest and the deterioration rate is the lowest，next is the combination of TCM and western medicine， chemotherapy population effect is the worst.Conclusion (1)The table is applied in clinic very well and can fully evaluate the post-treatment QOL of tumor patiens so that it applies the post-treatment effect that TCM’s anti-tumor’s effect is very significant;QOL rise largely and existence phase is long，but chemotherapy’s effect is the worst，QOL isn’t improved significantly.The key point of the effect of combination of TCM and western medicine is the excerpt of therapy measure in stationary phase，when chemotherapy conjugates with TCM rightly，which will has synergistic action.On the contrary，that’s will accelerate deterioration，existence phase is short，but the TCM bundle is on the contrary，after the stationary phase，it will trend to improve，the combination of TCM and western medicine is middle.
【Key words】 table of life quality carcinoma of stomach TCM combination of TCM and western medicine
“无瘤生存”是现代医学治愈肿瘤的金标准。然而，迄今为止，仍以手术、放疗、化疗作为治疗恶性肿瘤的主要手段，其疗效尚未有突破性进展。由于肿瘤细胞的无限分裂增殖，而一定量的抗癌药是按一定比率杀灭癌细胞的，因此，要达到肿瘤的完全杀灭——“无瘤生存”只是一个理想的目标。
因此在强调提高疗效的前提下，力求提高患者的生存质量，延长生存期，并把生存质量的测评纳入到疗效评价中，对于临床晚期胃癌患者将具有真正的实际意义。
鉴于目前国内还没有一个被广泛认可且能很好地评价生存质量的量表，尤其是在用中医药领域，并且现今国内在将生存质量引入到抗肿瘤疗效评价方面的研究还处于起始阶段，尤其是在通过评价生存质量对比各种方法抗肿瘤的疗效上还处于空白，因此根据国内外有关量表的文献资料，进一步修改和完善，尝试性地编制了具有中医药特色的中西医结合量表，来评价中医、西医及中西医结合方法对提高中晚期胃癌患者生存质量的疗效，以此试图解开长久以来令临床医师纷争不已的医学困惑，这将有助于指导临床治疗方案的选择，在目前医疗水平还不能彻底治愈癌症的前提下，将有助于更好地体现晚期癌症患者的生命意义和价值，同时也对中医药抗肿瘤的作用与地位给予正确客观的评价。具体如下。
1 量表的编制及应用
1.1 量表的编制与执行方法 见表1。
本表在原有国内外较为通行认可的量表WHOQOL100的基础上（生理、心理、独立性、社会关系、环境、精神）更加完善，增添了客观生化指标理化检查系列，中医八纲辩证、舌脉、情志等方面，及西医病理分期、诊断等。
该表为自评式问卷，每个指标，有2组选择答案，分别为治疗后好转或加重，每组又分5个程度选项，由1～5逐级递增，±1表治疗后病情变化程度最小，±5表治疗后病情变化程度最大。在统计时，1～5分别代表1到5分，填表时完全凭患者主观感受及耐受程度来完成。将一定时间治疗前后所有指标得分分数相加，正负分数可等量抵消，即为患者的自评分，治疗前后的正负项分数和即为疗效对照，分数相差越大，说明疗效越好，生存质量越高，或是说明病情恶化；分数差值小，说明病情稳定，长期跟踪随访，可得出远期疗效。因本表取的是治疗前后分数差值，故所规定的分数权重对结果无影响。本表所列的主客观症状、体征、心理及实验室指标等较为全面，故可评价治疗前后的疗效。
1.2 病例资料 选取1999～2003年本院肿瘤科及中医科病房和门诊的病人及地区中心医院中医肿瘤科的病人。入院前均经胃镜取活检及病史证实胃癌的患者576例。其中因失访（联系地址不详、错误等），拒绝再次随访等损失98例，实际完成最终调查的患者478例（其中化疗组204例，中西医结合组110例，中药组114例，地区中心医院共收集病例50例）。所有患者均进行2次以上测量，取平均值，量表执行均为患者本人或患者家属口述，医生代为执行。调查前，将量表的规则及各项含义详细向患者说明，并向患者讲明此项调查的意义
