中西醫治療大腸癌合併缺鐵性貧血之病例報告

Cancer Complicated with Iron Deficiency Anemia Treated with Traditional Chinese Medicine: A Case Report

大腸直腸癌長年佔據國內十大癌症死亡原因的前三位，2017年衛生福利部統計大腸直腸癌死亡率為僅次於肺癌與肝癌。大腸直腸癌中升結腸的腫瘤相對降結腸的腫瘤而言，阻塞症狀可較不明顯，多以產生潰瘍，間歇性出血，因而發生肉眼不易辨別的血便，而出現疲勞、心悸、心絞痛作為主要症狀，暗示著缺鐵性貧血的發生與加重。本篇病例報告報導一位53歲已停經女性，有子宮肌瘤合併貧血病史，於2015年7月因為發燒與腹脹就診，經血液腫瘤科診察後再次診斷為缺鐵性貧血，懷疑有腸胃道出血的可能。2015年11月因漸進性腹脹與持續頭暈而住院，經過系列檢查後診斷為大腸癌第四期；除了安排手術、緩和性化療處方與標靶治療以外，同時開立鐵劑予病人使用；但病人出現腸胃道副作用而不願意繼續服用鐵劑，隔年2016年1月開始於本院中醫門診調治，中醫診斷為虛勞、腸蕈，證型為肝腎陰虛，肝陽上亢，氣血兩虛，并有痰濕瘀濁下注，治則為平肝養陰，補益氣血，健脾滲濕，化瘀。經過系列中藥調理後，病人的疲倦等主觀症狀有明顯改善，且貧血部分也由實驗室檢驗確認回復至正常範圍，病人得以持續接受西醫化療。我們希望藉由此個案說明中醫藥輔助治療大腸癌合併之缺鐵性貧血之療效。 Colorectal cancer is the third lading cause of cancer death in Taiwan. There may be less obstructive symptoms in ascending colon tumors. Otherwise, ascending colon tumors usually produce ulcers that intermittently bleed, resulting occult blood loss. Other typical symptoms related to ascending colon tumors may be fatigue, palpitations, and angina. This case reports a 53 year old female with known history of menopause, uterine myoma and anemia, who came to clinic for fever and abdominal bloating sensation in July 2015. Iron deficiency anemia was diagnosed. Gastrointestinal origin blood loss was suspected. However, the patient was admitted to hospital in November 2015 due to progressive abdominal distension and persistent dizziness. After serial study, colorectal cancer, stage IV was diagnosed. Colorectal tumor resection and palliative chemotherapy, target therapy were arranged. Oral Iron supplement was prescribed. However, there was obvious GI upset after oral iron supplement so the patient stopped the treatment and seek for Traditional Chinese Medicine (TCM) therapy in January 2016. The patient had obvious fatigue sensation, dizziness, and persistent anemia despite colorectal tumor resection. The diagnosis according to TCM theory were liver and kidney yin deficiency, liver yang excess, blood and qi deficiency, phlegm-dampness and blood stagnation and fall. The treatment principle were harmonizing the liver and spleen, liver yin supplement, blood and qi supplement, fortifying the spleen and disinhibiting dampness, and dispelling stasis. After serial Chinese medicine usage, the patient had fatigue and anemia improved so that the patient could tolerated the following chemotherapy regimen. We hope the case could be used to illustrate the efficacy of TCM therapy for colorectal cancer related iron deficiency anemia.