术式改进对肺癌氩氦刀术后并发症及中医药治疗的影响研究
|
摘要
原发性肺癌(以下简称肺癌)是目前最常见的恶性肿瘤之一,其发病率、死亡率日益增长,呈现逐年上升的趋势。2010年卫生统计年鉴显示,2005年,肺癌死亡率占我国恶性肿瘤死亡率的第1位。随着科技的进步,各个学科的发展,目前肺癌的治疗强调有计划、合理地应用手术、化疗、放疗及微创治疗技术和生物靶向等治疗手段形成多学科综合治疗(MDT)模式。微创治疗作为其重要的一个分支,为肺癌治疗提供新的可靠途径。近年来,肺癌氩氦刀冷冻联合中医药治疗优势互补,从而形成一种更加完善和成熟的手术术式,为中晚期肺癌治疗提供更有效的方法。
本研究分为文献综述和临床研究两部分。在文献综述部分,概览了目前肺癌常见的微创治疗方法及其并发症的研究概况,回顾总结肺癌的中医病机特点及肺癌微创治疗后常见并发症的中医治疗。在临床研究部分,本课题在总结研究当前肺癌氩氦刀治疗的术式及与其相关的并发症情况的基础上,积极的将影像学等学科的进步同本科室临床中总结的成功经验有机结合,从而促进对肺癌氩氦刀术式积极改进,确定肺癌氩氦刀治疗新术式。并通过前瞻性的临床研究,对照研究东方医院肿瘤科改进肺癌氩氦刀术式前后并发症的变化,明确肺癌氩氦刀术式改进后其并发症发生率明显降低、严重并发症发生减少,并发症严重程度明显减轻,患者术后恢复快。对照研究肺癌氩氦刀术式改变前后联合中医药治疗时辨证论治过程中理、法、方、药变化,从而总结形成更为完善和成熟的氩氦刀联合中医药治疗方案,为中晚期肺癌治疗提供更有效的方法。
回顾性研究东方医院肿瘤科从2003年8月至2008年12月31日行肺癌氩氦刀手术患者115例,观察其术后并发症情况及联合应用中医药治疗的情况,结合前瞻性研究我科总结经验提出氩氦刀术式改进后,2009年至2011年10月行肺癌氩氦刀手术患者121例,对照分析氩氦刀术式改进后并发症的变化,及肺癌氩氦刀术后联合中医药治疗时辨证论治过程中理、法、方、药变化。
肺癌氩氦刀术式改进主要包括1.提出术前模拟计划的概念。根据患者术前PET-CT或相应体位增强CT明确肿瘤大小、病灶活性、及其周围组织及脏器情况拟定氩氦刀数量、穿刺方向。其一.应用PET-CT明确肿瘤病灶活性所在,指导冷冻策略及消融靶区,在治疗策略方面强调先消融其活性高的病灶组织以遏制其肿瘤的生长扩散的病势、后最大范围的消融相对代谢活性较弱的周围组织已达到除恶务尽的效果,治疗过程中更能有的放矢,提高治疗靶向性。其二.应用CT三位重建技术明确肺部主要血管及气管等重要器官位置,指导穿刺、冷冻消融操作,从而避免了损伤大血管、气管、纵膈等重要脏器,明显降低了大咯血、损伤气管等并发症发生率。2.穿刺操作中应用鞘管.扩张管明显减少进刀过程中对组织的损伤,鞘管的密闭性减少了气胸、出血等并发症的发生几率,并为术中术后局部处理及给药提供途径。3.多刀联合时运用STICK模式,固定已到位冷刀,减少并发症,并保证多刀同步快速冷冻,扩大冷冻范围,提高冷冻效果。4.升温后快速出刀,重视术后CT扫描,观察急性并发症情况。
结果显示：①氩氦刀术式改变后其并发症发生率明显降低,严重并发症发生显著减少,并发症严重程度显著减轻,术后出血、咯血、胸腔积液、肺部感染等较严重并发症发生率明显低于改进前。故其微创性,靶向性等优点更加显著,患者术后恢复时间缩短,疗效确切。②肺癌氩氦刀术式改进前后并发症构成发生了明显变化,从而引起术后联合中医药治疗过程中,其中医辨证、治法、方药等明显改变。氩氦刀术式改进前,肺癌氩氦刀术后主要辩证以血证、痰证为主证,其中实证主要以气滞血瘀、痰瘀互结、痰热壅肺为常见证型；虚证中主要以气阴两虚、肺脾两虚为常见证型；故中医治法强调化瘀止血、化痰止咳。选药主要以止血药、止咳平喘药、补益药为主。中成药应用在扶正抗癌基础上,强调止血理血药的应用,这与术后咳血并发症相关。氩氦刀术式改进后,患者咳血、气胸等并发症明显减少,术后中医辨证主要以痰证为主证,其中实证以痰湿壅肺、痰热壅肺、痰瘀互结及湿热中阻为主要证型,虚证中主要以肺肾两虚、肺脾两虚及气阴两虚为常见证型,故中医治法强调化痰排脓、健脾益肺。选药主要以祛痰止咳、理肺健脾为主。中成药应用强调祛痰止咳、补肺宜肺平喘等。
Primary lung cancer(lung cancer)is one of the frequent malignant tumor in the world.The disease rate and death rate is increasing day by day.Which shows the ascending trend.The death rate of the lung cancer becomes the number one in the death rate of the all malignant tumor in2005which shows in2011Health Statistics Yearbook.
With the technological progressing,various discipline developing,the treatment of the lung cancer emphasis combined modality treatment which includes°opertaion. chemotherapy, radiotherapy、 minimally invasive iatrotechnics and biology target.Minimally invasive treatment conducts one of the important branch,which provides new safety ways treatment in lung cancer.For the past few years,the unite of the Argon Helium Cryoablation and Herb Therapy becomes more and more consummate,which provides effective ways in middle and advanced lung cancer.
Content:
The research includes literature summarize and clinical studies.In the literature summarize,we will introduce the research of the popular therapy in t minimally invasive and complication of the lung cancer.,review the character of the pathogenesis and the herb therapy of the complication after minimally invasive. In clinical research,on one hand,we will summarize the technical style in the Argon Helium Cryoablation therapy and the correlated complication，on one hand,we will introduce the progress of the iconography discipline and some success experiences in our clinical therapy,which can promote the technique in the Argon Helium Cryoablation therapy. In clinical prospective research,we will contast the the change of the complication in the forward and behind Argon Helium Cryoablation therapy through the prospective research,through the research we can identify the incidence rate of the complication obviously decrease,and postoperative recovery soon after the improvement of the Argon Helium Cryoablation therapy.
Though the control research in the unit of the Argon Helium Cryoablation therapy and herb therapy,we can summarise that the Treatment Protocols which unit the Argon Helium Cryoablation therapy and herb therapy becomes more and more better,it can provide the effective ways for patient.
Methods:
From8.2003to12.2008,we observe the operation complication after two weeks,and the result after the herb therapy through the115patients who did the operation of the Argon Helium Cryoablation therapy in Dongfang hospital Oncology Service,then our department improves the Argon Helium Cryoablation therapy.We contrast analysis the change after operation and the unit of the herb therapy trough the121patients from2009to October2011.
Results:
The improvement of Argon Helium Cryoablation therapy mainly includes some aspects,one is the concept of simulation scheming before the operation. According the size of the tumor、 focus liveness and the condition of the environment organization through the PET-CT or posture reinforce CT,we can lay the quantity and paracentesis direction of the Argon Helium..Through the PET-CT,we can identify the place of the tumor focus liveness,then we can ablate the high liveness organization to limit the tendency of disease of the grown diffused,after use it,we can shoot the arrow at the targe in therapy processing,elevate the therapy targe.The second is that after using the CT three position reconstruction technique,we can identify the position of the important blood vessel and trachea,then that can guide the operation of the paracentesis and Cryoablation,which can avoid the damage of the important organization such as blood vessel、 mediastimus and so on.The third is that after using sheathing canal,can obsviously decrease the concidence rate of the pneumothorax and hemorrhage,it also can provide the new administration ways in the processing of the paracentesis and freezing.
Conclusion:
①the complication incidence rate obviously decrease after the improving of the Argon Helium Cryoablation therapy.Such as hemorrhage, hemoptysis、 pleural effusion、 pulmonary infection and so on.So we can say it can shorten the recovery time because of the good quality of the target and minimally invasive.
②Because of the obviously stucture chang after anterior-posterior in Argon Helium Cryoablation therapy,the differentiating zheng、 rule and formula obsviously have changed.Before theimproving,after operaion,the primary dialectical is accumulation of phlegm stasis and damage of arteries and veins.So we can hua yu zhi xue and hua tan zhi ke.Afrer the improving of operation,we discover the primary principal syndrome is phlegm-stasis obstructing the lung and lung-spleen concurrent insufficiency.We can use dissipate phlegm、discharge of pus and strengthening the spleen and replenishing qi.
本研究分为文献综述和临床研究两部分。在文献综述部分,概览了目前肺癌常见的微创治疗方法及其并发症的研究概况,回顾总结肺癌的中医病机特点及肺癌微创治疗后常见并发症的中医治疗。在临床研究部分,本课题在总结研究当前肺癌氩氦刀治疗的术式及与其相关的并发症情况的基础上,积极的将影像学等学科的进步同本科室临床中总结的成功经验有机结合,从而促进对肺癌氩氦刀术式积极改进,确定肺癌氩氦刀治疗新术式。并通过前瞻性的临床研究,对照研究东方医院肿瘤科改进肺癌氩氦刀术式前后并发症的变化,明确肺癌氩氦刀术式改进后其并发症发生率明显降低、严重并发症发生减少,并发症严重程度明显减轻,患者术后恢复快。对照研究肺癌氩氦刀术式改变前后联合中医药治疗时辨证论治过程中理、法、方、药变化,从而总结形成更为完善和成熟的氩氦刀联合中医药治疗方案,为中晚期肺癌治疗提供更有效的方法。
回顾性研究东方医院肿瘤科从2003年8月至2008年12月31日行肺癌氩氦刀手术患者115例,观察其术后并发症情况及联合应用中医药治疗的情况,结合前瞻性研究我科总结经验提出氩氦刀术式改进后,2009年至2011年10月行肺癌氩氦刀手术患者121例,对照分析氩氦刀术式改进后并发症的变化,及肺癌氩氦刀术后联合中医药治疗时辨证论治过程中理、法、方、药变化。
肺癌氩氦刀术式改进主要包括1.提出术前模拟计划的概念。根据患者术前PET-CT或相应体位增强CT明确肿瘤大小、病灶活性、及其周围组织及脏器情况拟定氩氦刀数量、穿刺方向。其一.应用PET-CT明确肿瘤病灶活性所在,指导冷冻策略及消融靶区,在治疗策略方面强调先消融其活性高的病灶组织以遏制其肿瘤的生长扩散的病势、后最大范围的消融相对代谢活性较弱的周围组织已达到除恶务尽的效果,治疗过程中更能有的放矢,提高治疗靶向性。其二.应用CT三位重建技术明确肺部主要血管及气管等重要器官位置,指导穿刺、冷冻消融操作,从而避免了损伤大血管、气管、纵膈等重要脏器,明显降低了大咯血、损伤气管等并发症发生率。2.穿刺操作中应用鞘管.扩张管明显减少进刀过程中对组织的损伤,鞘管的密闭性减少了气胸、出血等并发症的发生几率,并为术中术后局部处理及给药提供途径。3.多刀联合时运用STICK模式,固定已到位冷刀,减少并发症,并保证多刀同步快速冷冻,扩大冷冻范围,提高冷冻效果。4.升温后快速出刀,重视术后CT扫描,观察急性并发症情况。
结果显示：①氩氦刀术式改变后其并发症发生率明显降低,严重并发症发生显著减少,并发症严重程度显著减轻,术后出血、咯血、胸腔积液、肺部感染等较严重并发症发生率明显低于改进前。故其微创性,靶向性等优点更加显著,患者术后恢复时间缩短,疗效确切。②肺癌氩氦刀术式改进前后并发症构成发生了明显变化,从而引起术后联合中医药治疗过程中,其中医辨证、治法、方药等明显改变。氩氦刀术式改进前,肺癌氩氦刀术后主要辩证以血证、痰证为主证,其中实证主要以气滞血瘀、痰瘀互结、痰热壅肺为常见证型；虚证中主要以气阴两虚、肺脾两虚为常见证型；故中医治法强调化瘀止血、化痰止咳。选药主要以止血药、止咳平喘药、补益药为主。中成药应用在扶正抗癌基础上,强调止血理血药的应用,这与术后咳血并发症相关。氩氦刀术式改进后,患者咳血、气胸等并发症明显减少,术后中医辨证主要以痰证为主证,其中实证以痰湿壅肺、痰热壅肺、痰瘀互结及湿热中阻为主要证型,虚证中主要以肺肾两虚、肺脾两虚及气阴两虚为常见证型,故中医治法强调化痰排脓、健脾益肺。选药主要以祛痰止咳、理肺健脾为主。中成药应用强调祛痰止咳、补肺宜肺平喘等。
Primary lung cancer(lung cancer)is one of the frequent malignant tumor in the world.The disease rate and death rate is increasing day by day.Which shows the ascending trend.The death rate of the lung cancer becomes the number one in the death rate of the all malignant tumor in2005which shows in2011Health Statistics Yearbook.
With the technological progressing,various discipline developing,the treatment of the lung cancer emphasis combined modality treatment which includes°opertaion. chemotherapy, radiotherapy、 minimally invasive iatrotechnics and biology target.Minimally invasive treatment conducts one of the important branch,which provides new safety ways treatment in lung cancer.For the past few years,the unite of the Argon Helium Cryoablation and Herb Therapy becomes more and more consummate,which provides effective ways in middle and advanced lung cancer.
Content:
The research includes literature summarize and clinical studies.In the literature summarize,we will introduce the research of the popular therapy in t minimally invasive and complication of the lung cancer.,review the character of the pathogenesis and the herb therapy of the complication after minimally invasive. In clinical research,on one hand,we will summarize the technical style in the Argon Helium Cryoablation therapy and the correlated complication，on one hand,we will introduce the progress of the iconography discipline and some success experiences in our clinical therapy,which can promote the technique in the Argon Helium Cryoablation therapy. In clinical prospective research,we will contast the the change of the complication in the forward and behind Argon Helium Cryoablation therapy through the prospective research,through the research we can identify the incidence rate of the complication obviously decrease,and postoperative recovery soon after the improvement of the Argon Helium Cryoablation therapy.
Though the control research in the unit of the Argon Helium Cryoablation therapy and herb therapy,we can summarise that the Treatment Protocols which unit the Argon Helium Cryoablation therapy and herb therapy becomes more and more better,it can provide the effective ways for patient.
Methods:
From8.2003to12.2008,we observe the operation complication after two weeks,and the result after the herb therapy through the115patients who did the operation of the Argon Helium Cryoablation therapy in Dongfang hospital Oncology Service,then our department improves the Argon Helium Cryoablation therapy.We contrast analysis the change after operation and the unit of the herb therapy trough the121patients from2009to October2011.
Results:
The improvement of Argon Helium Cryoablation therapy mainly includes some aspects,one is the concept of simulation scheming before the operation. According the size of the tumor、 focus liveness and the condition of the environment organization through the PET-CT or posture reinforce CT,we can lay the quantity and paracentesis direction of the Argon Helium..Through the PET-CT,we can identify the place of the tumor focus liveness,then we can ablate the high liveness organization to limit the tendency of disease of the grown diffused,after use it,we can shoot the arrow at the targe in therapy processing,elevate the therapy targe.The second is that after using the CT three position reconstruction technique,we can identify the position of the important blood vessel and trachea,then that can guide the operation of the paracentesis and Cryoablation,which can avoid the damage of the important organization such as blood vessel、 mediastimus and so on.The third is that after using sheathing canal,can obsviously decrease the concidence rate of the pneumothorax and hemorrhage,it also can provide the new administration ways in the processing of the paracentesis and freezing.
Conclusion:
①the complication incidence rate obviously decrease after the improving of the Argon Helium Cryoablation therapy.Such as hemorrhage, hemoptysis、 pleural effusion、 pulmonary infection and so on.So we can say it can shorten the recovery time because of the good quality of the target and minimally invasive.
②Because of the obviously stucture chang after anterior-posterior in Argon Helium Cryoablation therapy,the differentiating zheng、 rule and formula obsviously have changed.Before theimproving,after operaion,the primary dialectical is accumulation of phlegm stasis and damage of arteries and veins.So we can hua yu zhi xue and hua tan zhi ke.Afrer the improving of operation,we discover the primary principal syndrome is phlegm-stasis obstructing the lung and lung-spleen concurrent insufficiency.We can use dissipate phlegm、discharge of pus and strengthening the spleen and replenishing qi.
引文
[1]王洪武,杨仁杰主编,肿瘤微创治疗技术.北京：北京科学技术出版社.2007：236—237
[2]刘传波,CT引导下氩氦刀靶向治疗肺癌的临床应用及改进,《北京中医药大学硕士论文》-2011-07-01.64-65
[3]易峰涛,宋华志,陈辉莉,等,氩氦刀联合放疗治疗晚期肺癌,实用癌症杂志,2004,19(5)；527-529
[4]冯华松,肺癌微创治疗新技术及其进展,Journal of N avalG eneral H ospital,Vol.23 No.4, Dee2010.219
[5]刘传波氩氦刀联合中药治疗肺癌的临床研究《北京中医药大学硕士论文》2008-07-01.64-65
[6]王洪武,杨仁杰主编,肿瘤微创治疗技术.北京：北京科学技术出版社.2007：236—237
[7]彭秋平.氩氦超导手术系统氩氦刀[J].中华肿瘤杂志,1999,21(6)：488
[8]程颖,张彩霞,秦少波,氩氦刀治疗中晚期肺癌的临床观察,吉林医学,2005,26(6)；599-600
[9]胡凯文,姜敏,李占东等.氩氦刀冷冻联合中药治疗肺癌65例的临床观察[J].中华中医药杂志,2005,20(5)：295-297.
[10]Golberg SN,Gazelle GS,Halpern EF,etal.Radiofrequency tissue ablation:importance of local temperature along the electrode tipexposure in determining lesion shape and size [J]. Acad Radicol,1996, 3:212-218.
[11]马连君,程庆书,张卫强等.射频消融诱导兔肺内VX2鳞状细胞癌模型细胞凋亡[J].第四军医大学学报,2002,23(8)：725-727.
[12]Hiraki T, Sakurai J, Tsuda T, etal. Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors:evaluation based on a preliminary review of 342 tumors[J]. Cancer,2006,107:2873-2880
[13]Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radio-frequency ablation: long-term safety and efficacy in 153 patients[J]. Radiology, 2007,243:268-275
[14]支修益,CT引导下射频消融治疗肺癌,Journal of China Prescription Drug 2010.04, No.97; 45
[15]Zhu JC, Yan TD, Morris DL, et al. A systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol,2008,15(6):1765-1774.
[15]CHEN A, GALLOWAY M, LANDRCNEAU R, et al. Intraoperative 125-Ⅰ brachytherapy for high - risk stage I nonsmall cell lung carcinoma [J]. Int J Radiat Oncol B iolPhys,2000,6 (4):1083.
[16]柴树德,毛玉权,闰卫亮,等.三维立体定向种植放射性粒子近距离治疗肿瘤[J].临床肿瘤学杂志,2005,10(1)：77-79.
[17]胡建林,杨和平.经皮穿刺瘤体内植入125I粒子治疗肺癌的初步评价[J].重庆医学,2002,31(9)：774-775.
[18]柳立军,宋永彬,刘淑贞,王志康,段国辰,潘旭东,张华,周韶辉,赵文清,王士杰.CT引导下经皮穿刺植入(125)-I粒子组织间近距离治疗非小细胞肺癌的探讨[J].北京医学.2005(08).
[19]刘育新,罗鹏飞等,CT引导下125I粒子微创治疗肺癌32例分析,现代医院2010,10(1)专业技术篇：49-52
[20]赵学武,cT引导125I粒子植入治疗中晚期肺癌现代医用影像学,2008.17.(4)：176
[21]Lewis R, Caccavele RJ, Sisler GE, et al. One hundred consecutive patients undergoing video assisted thoracic operation [J].Ann Thorac Surg,1992,54:421
[22]Watanabe A, Osawa H, Watanabe T, et al. Complications of major lung resections by video—assisted thoracoscopic surgery [J]. Jap J Thorac Surg,2003,56(11):943-948.
[23]Mc Kenna RJ J r, Houck W, Fuller CB. Videoassis ted t horacicsurgery lobecto my:experience wit h 1,100 cases. Ann ThoracSurg,2006,81 (2):421-425.
[24]江文坛,电视胸腔镜肺癌根治术的临床研究《福建医科大学硕士研究生论文》2008.3-2009.3,11-13
[25]陈刚,肺癌微创外科治疗的现状及进展,中国微创外科杂志2008.8(11)：976
[26]许宗协,二生汤治疗肺癌咳嗽42例,中国中医药科技,2001,8(2)；130
[27]黄智芬,黎汉忠,谭志强,等,湖南中医杂志,2002,18(4)；7-8
[28]吴玉华,蒋益兰,青蒿鳖甲汤加味治疗肺癌发热20例,湖南中医杂志,1997,13(5)；27-28
[29]李发枝,小柴胡汤治疗肺癌发热,河南中医,1996,16(2)；12-13
[30]杨波,白虎汤治疗癌性发热42例[J]广东医学,2004,25(11)：1262.
[31]左明焕,孙韬,姜敏,中医药在治疗肺癌并发症中的应用,北京中医药大学学报(中医临床版)2009,16(2)：43-45.
[32]陈四清,大黄牛角汤治疗肺癌(瘀热型)大咯血探讨,中国中医药信息杂志,20()3,10(3)；6-7
[33]郭芹,辨证冶疗肺癌急症咯血的临床观察,中华实用中西医杂志,2002,2(15)；1291-1292
[34]刘丽华,郑春梅,中医对肺癌咳血的辨证施治,河南中医,2000,4；25
[35]王淑琳,冯基亚,李琼,辨证治疗肺癌急症咯血的临床观察,中华实用中西医 杂志,2002,2(15)；1291-1292
[36]张泉,中西医结合治疗肺癌咯血62例疗效观察,吉林中医药,2000,1；46-47
[37]邵宏敏,侯爱画,中西医结合治疗老年肺癌咯血5例,中国中医急症,2004,13(5)；329-330
[38]宋洪恩,周艳丽,张秀贞,滋肺解毒汤合渗湿泄下散治疗肺癌并发胸水106例疗效观察,河北中医,2004,26(1)；28-29
[39]朱宝龙,徐曜灵,白芨煎液超声雾化吸入治疗肺癌咯血28例疗效观察,江苏临床医学杂志,2000,4(2)；102
[40]宋恩峰,张湘云,任开明,上病下取治疗肺癌咯血临床观察,中国中医急症,2000,9(3)；133
[41]蔡金莲,王爱平,黄天本,爱迪注射液胸腔及静脉治疗肺癌胸水近期疗效观察,实用中西医结合临床,2004,4(3)；16-17
[42]陈萍,王爱华,于钦凤,等,艾迪注射液治疗肺癌胸腔积液15例疗效观察,山东医药,2003,43(31)；55
[43]李竹英,刘建秋,王珏,扶正逐饮汤联合胸腔内灌注治疗肺癌胸水的临床研究,中医药信息,2005,22(4)；63-64
[44]罗继跃,丹参注射液加顺铂治疗肺癌恶性胸水临床观察,江西中医药,2003,34(241)：19
[45]孙在典,张爱琴,复方葶苈大枣泻肺汤合用顺铂治疗肺癌恶性胸腔积液38例,浙江中医学院学报,2005,29(2)；21-22
[46]惠雅琳,刘惠珍,康莱特胸腔注入联合全身化疗治疗非小细胞肺癌胸腔积液,现代肿瘤医学,2003,11(2)；130-131
[47]王云启,黄立中,温阳益气散结泄水法联合胸腔灌注顺铂治疗肺癌性胸水疗效观察,中国中医药信息杂志,2005,12(3)；12-13
[48]李青兰, 张灵智,侯子训,益肺清化膏联合顺铂胸腔灌注治疗肺癌胸水30例,华夏医学,2004,17(3)；417-418
[49]毕湘杰,陈防,补中益气汤加减治疗肺癌晚期胸腔积液1例,中医药信息,2001,18(5)；39
[50]王宏伟.中药缓解癌性疼痛近况山东中医杂志2003,3：24
[51]章士华,关佩娴,袁长青,袁维纲,谭文,张瑜.痛宁药袋治疗癌性疼痛210例[J].陕西中医.1998,11(4)
[52]孙玉冰,周亦农,张诚光等.癌痛宁散外敷治疗癌性疼痛45例[J].中医药学刊,2005,23(4)：728
[53]芦连菊,痛舒膏外敷治疗癌性疼痛[J].山东中医杂志.1998,17(5)
[54]稽玉峰,黄金活,梁洪江等.乳香止痛膏外敷治疗肝癌疼痛26例临床观察[J].江西中医学院学报,2005,17(2)：31～32
[55]王劲,克奎钧,金炳根等.华佗麻药神方温阳止痛外治癌痛82例[J].实用中西医结合杂志,1996,9(1)：13～14
[56]吴琪,李德民.速效止痛拔痛膏治疗癌性疼痛156例[J].辽宁中医志,1996,23(3)：137
[57]杨瑞利,曲培莲.中药局部外擦治疗癌性疼痛[J].肿瘤防治杂志,2001,7(2)：174
[58]李道乾,癌痛消除剂治疗癌性疼痛[J].中国中医药信息杂志,2001,7(2)：174
[59]周韩军,贺红艳,中药贴敷法治疗肝肺癌晚期疼痛168例临床观察,光明中医杂志,1997,2；29-30
[60]况红艳,痰热清注射液治疗肺癌晚期合并肺部感染的临床观察,中原医刊,2005,32(18)；73-74
[61]胡凯文,王芬,左明焕,等,中晚期肺癌患者合并肺部细菌感染的中医证候危险因素分析,中国中医基础医学杂志,2004,10(8)；45-46
[62]王思勤,马希涛,潘金兵,痰热清注射液治疗肺癌晚期合并肺部感染28例,中医研究,2004,17(6)；31
[1]赵平,原发性肺癌诊疗规范(2011年版)[z].中国肿瘤临床年鉴.2010：328-347.
[2]邢淑琴,CT引导下氩氦刀靶向治疗肺癌的临床应用及改进《北京中医药大学硕士论文》-2011-07-01.64-65
[3]朱文峰.中医诊断学[M].北京：中国中医药出版社,2002：177-181.
[4]国家中医药管理局.中华人民共和国中医药行业标准*中医病证诊断疗效标准[S].南京：南京大学出版社,1994：7。
[5]谢鸣,方剂学[M].北京：人民卫生出版社,2002：39-472.
[6]高学敏.中药学[M].北京：中国中医药出版社,2000：45-456.
[7]赵国平.中医药大辞典[M].上海：上海科学技术出版社,2005：3091.)
[2]刘传波,CT引导下氩氦刀靶向治疗肺癌的临床应用及改进,《北京中医药大学硕士论文》-2011-07-01.64-65
[3]易峰涛,宋华志,陈辉莉,等,氩氦刀联合放疗治疗晚期肺癌,实用癌症杂志,2004,19(5)；527-529
[4]冯华松,肺癌微创治疗新技术及其进展,Journal of N avalG eneral H ospital,Vol.23 No.4, Dee2010.219
[5]刘传波氩氦刀联合中药治疗肺癌的临床研究《北京中医药大学硕士论文》2008-07-01.64-65
[6]王洪武,杨仁杰主编,肿瘤微创治疗技术.北京：北京科学技术出版社.2007：236—237
[7]彭秋平.氩氦超导手术系统氩氦刀[J].中华肿瘤杂志,1999,21(6)：488
[8]程颖,张彩霞,秦少波,氩氦刀治疗中晚期肺癌的临床观察,吉林医学,2005,26(6)；599-600
[9]胡凯文,姜敏,李占东等.氩氦刀冷冻联合中药治疗肺癌65例的临床观察[J].中华中医药杂志,2005,20(5)：295-297.
[10]Golberg SN,Gazelle GS,Halpern EF,etal.Radiofrequency tissue ablation:importance of local temperature along the electrode tipexposure in determining lesion shape and size [J]. Acad Radicol,1996, 3:212-218.
[11]马连君,程庆书,张卫强等.射频消融诱导兔肺内VX2鳞状细胞癌模型细胞凋亡[J].第四军医大学学报,2002,23(8)：725-727.
[12]Hiraki T, Sakurai J, Tsuda T, etal. Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors:evaluation based on a preliminary review of 342 tumors[J]. Cancer,2006,107:2873-2880
[13]Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radio-frequency ablation: long-term safety and efficacy in 153 patients[J]. Radiology, 2007,243:268-275
[14]支修益,CT引导下射频消融治疗肺癌,Journal of China Prescription Drug 2010.04, No.97; 45
[15]Zhu JC, Yan TD, Morris DL, et al. A systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol,2008,15(6):1765-1774.
[15]CHEN A, GALLOWAY M, LANDRCNEAU R, et al. Intraoperative 125-Ⅰ brachytherapy for high - risk stage I nonsmall cell lung carcinoma [J]. Int J Radiat Oncol B iolPhys,2000,6 (4):1083.
[16]柴树德,毛玉权,闰卫亮,等.三维立体定向种植放射性粒子近距离治疗肿瘤[J].临床肿瘤学杂志,2005,10(1)：77-79.
[17]胡建林,杨和平.经皮穿刺瘤体内植入125I粒子治疗肺癌的初步评价[J].重庆医学,2002,31(9)：774-775.
[18]柳立军,宋永彬,刘淑贞,王志康,段国辰,潘旭东,张华,周韶辉,赵文清,王士杰.CT引导下经皮穿刺植入(125)-I粒子组织间近距离治疗非小细胞肺癌的探讨[J].北京医学.2005(08).
[19]刘育新,罗鹏飞等,CT引导下125I粒子微创治疗肺癌32例分析,现代医院2010,10(1)专业技术篇：49-52
[20]赵学武,cT引导125I粒子植入治疗中晚期肺癌现代医用影像学,2008.17.(4)：176
[21]Lewis R, Caccavele RJ, Sisler GE, et al. One hundred consecutive patients undergoing video assisted thoracic operation [J].Ann Thorac Surg,1992,54:421
[22]Watanabe A, Osawa H, Watanabe T, et al. Complications of major lung resections by video—assisted thoracoscopic surgery [J]. Jap J Thorac Surg,2003,56(11):943-948.
[23]Mc Kenna RJ J r, Houck W, Fuller CB. Videoassis ted t horacicsurgery lobecto my:experience wit h 1,100 cases. Ann ThoracSurg,2006,81 (2):421-425.
[24]江文坛,电视胸腔镜肺癌根治术的临床研究《福建医科大学硕士研究生论文》2008.3-2009.3,11-13
[25]陈刚,肺癌微创外科治疗的现状及进展,中国微创外科杂志2008.8(11)：976
[26]许宗协,二生汤治疗肺癌咳嗽42例,中国中医药科技,2001,8(2)；130
[27]黄智芬,黎汉忠,谭志强,等,湖南中医杂志,2002,18(4)；7-8
[28]吴玉华,蒋益兰,青蒿鳖甲汤加味治疗肺癌发热20例,湖南中医杂志,1997,13(5)；27-28
[29]李发枝,小柴胡汤治疗肺癌发热,河南中医,1996,16(2)；12-13
[30]杨波,白虎汤治疗癌性发热42例[J]广东医学,2004,25(11)：1262.
[31]左明焕,孙韬,姜敏,中医药在治疗肺癌并发症中的应用,北京中医药大学学报(中医临床版)2009,16(2)：43-45.
[32]陈四清,大黄牛角汤治疗肺癌(瘀热型)大咯血探讨,中国中医药信息杂志,20()3,10(3)；6-7
[33]郭芹,辨证冶疗肺癌急症咯血的临床观察,中华实用中西医杂志,2002,2(15)；1291-1292
[34]刘丽华,郑春梅,中医对肺癌咳血的辨证施治,河南中医,2000,4；25
[35]王淑琳,冯基亚,李琼,辨证治疗肺癌急症咯血的临床观察,中华实用中西医 杂志,2002,2(15)；1291-1292
[36]张泉,中西医结合治疗肺癌咯血62例疗效观察,吉林中医药,2000,1；46-47
[37]邵宏敏,侯爱画,中西医结合治疗老年肺癌咯血5例,中国中医急症,2004,13(5)；329-330
[38]宋洪恩,周艳丽,张秀贞,滋肺解毒汤合渗湿泄下散治疗肺癌并发胸水106例疗效观察,河北中医,2004,26(1)；28-29
[39]朱宝龙,徐曜灵,白芨煎液超声雾化吸入治疗肺癌咯血28例疗效观察,江苏临床医学杂志,2000,4(2)；102
[40]宋恩峰,张湘云,任开明,上病下取治疗肺癌咯血临床观察,中国中医急症,2000,9(3)；133
[41]蔡金莲,王爱平,黄天本,爱迪注射液胸腔及静脉治疗肺癌胸水近期疗效观察,实用中西医结合临床,2004,4(3)；16-17
[42]陈萍,王爱华,于钦凤,等,艾迪注射液治疗肺癌胸腔积液15例疗效观察,山东医药,2003,43(31)；55
[43]李竹英,刘建秋,王珏,扶正逐饮汤联合胸腔内灌注治疗肺癌胸水的临床研究,中医药信息,2005,22(4)；63-64
[44]罗继跃,丹参注射液加顺铂治疗肺癌恶性胸水临床观察,江西中医药,2003,34(241)：19
[45]孙在典,张爱琴,复方葶苈大枣泻肺汤合用顺铂治疗肺癌恶性胸腔积液38例,浙江中医学院学报,2005,29(2)；21-22
[46]惠雅琳,刘惠珍,康莱特胸腔注入联合全身化疗治疗非小细胞肺癌胸腔积液,现代肿瘤医学,2003,11(2)；130-131
[47]王云启,黄立中,温阳益气散结泄水法联合胸腔灌注顺铂治疗肺癌性胸水疗效观察,中国中医药信息杂志,2005,12(3)；12-13
[48]李青兰, 张灵智,侯子训,益肺清化膏联合顺铂胸腔灌注治疗肺癌胸水30例,华夏医学,2004,17(3)；417-418
[49]毕湘杰,陈防,补中益气汤加减治疗肺癌晚期胸腔积液1例,中医药信息,2001,18(5)；39
[50]王宏伟.中药缓解癌性疼痛近况山东中医杂志2003,3：24
[51]章士华,关佩娴,袁长青,袁维纲,谭文,张瑜.痛宁药袋治疗癌性疼痛210例[J].陕西中医.1998,11(4)
[52]孙玉冰,周亦农,张诚光等.癌痛宁散外敷治疗癌性疼痛45例[J].中医药学刊,2005,23(4)：728
[53]芦连菊,痛舒膏外敷治疗癌性疼痛[J].山东中医杂志.1998,17(5)
[54]稽玉峰,黄金活,梁洪江等.乳香止痛膏外敷治疗肝癌疼痛26例临床观察[J].江西中医学院学报,2005,17(2)：31～32
[55]王劲,克奎钧,金炳根等.华佗麻药神方温阳止痛外治癌痛82例[J].实用中西医结合杂志,1996,9(1)：13～14
[56]吴琪,李德民.速效止痛拔痛膏治疗癌性疼痛156例[J].辽宁中医志,1996,23(3)：137
[57]杨瑞利,曲培莲.中药局部外擦治疗癌性疼痛[J].肿瘤防治杂志,2001,7(2)：174
[58]李道乾,癌痛消除剂治疗癌性疼痛[J].中国中医药信息杂志,2001,7(2)：174
[59]周韩军,贺红艳,中药贴敷法治疗肝肺癌晚期疼痛168例临床观察,光明中医杂志,1997,2；29-30
[60]况红艳,痰热清注射液治疗肺癌晚期合并肺部感染的临床观察,中原医刊,2005,32(18)；73-74
[61]胡凯文,王芬,左明焕,等,中晚期肺癌患者合并肺部细菌感染的中医证候危险因素分析,中国中医基础医学杂志,2004,10(8)；45-46
[62]王思勤,马希涛,潘金兵,痰热清注射液治疗肺癌晚期合并肺部感染28例,中医研究,2004,17(6)；31
[1]赵平,原发性肺癌诊疗规范(2011年版)[z].中国肿瘤临床年鉴.2010：328-347.
[2]邢淑琴,CT引导下氩氦刀靶向治疗肺癌的临床应用及改进《北京中医药大学硕士论文》-2011-07-01.64-65
[3]朱文峰.中医诊断学[M].北京：中国中医药出版社,2002：177-181.
[4]国家中医药管理局.中华人民共和国中医药行业标准*中医病证诊断疗效标准[S].南京：南京大学出版社,1994：7。
[5]谢鸣,方剂学[M].北京：人民卫生出版社,2002：39-472.
[6]高学敏.中药学[M].北京：中国中医药出版社,2000：45-456.
[7]赵国平.中医药大辞典[M].上海：上海科学技术出版社,2005：3091.)