题名

海扶術後運用中藥治療巨大子宮肌瘤病例報告

并列篇名

Traditional Chinese Medicine Treatment for Giant Uterine Fibroids after High-Intensity Focused Ultrasound Therapy: A Case Report

DOI

10.30030/JTCGM.202306_30(1).0005

作者

呂庭慈(Ting-Tzu Lu)；陳威君(Wei-Chun Chen)；鄭為仁(Wei-Jen Cheng)

关键词

子宮肌瘤 ； 癥瘕 ； 橘核 ； 桂枝茯苓丸 ； JAK2突變 ； 血小板增生症 ； 肌瘤性紅血球增生症候群 ； uterine fibroids ； Citrus reticulata Blanco seed ； Gui Zhi Fu Ling Wan ； JAK2 mutation ； thrombocytosis ； fibroid-induced polycythemia

期刊名称

中醫婦科醫學雜誌

卷期/出版年月

30卷1期（2023 / 06 / 01）

页次

40 - 54

内容语文

繁體中文;英文
中文摘要

子宮肌瘤為育齡婦女常見的良性腫瘤之一。本病例為一52歲女性，有Janus kinase2（JAK2）突變造成的血小板增生症病史，患有巨大子宮肌瘤，於2021年11月11日至桃園長庚紀念醫院中醫婦科就診，主訴為腹脹多年，患者已接受海扶刀手術，希望中西醫共同治療使肌瘤縮小。中醫診斷為癥瘕，辯證為氣滯血瘀，治則為疏肝解鬱、行氣散結、活血化瘀，治療上以橘核為君藥，經期頭三天則以桂枝茯苓丸為君藥。服中藥治療五個月後，患者自述下腹腫脹感減少顯著，外觀上腹部變小，自覺肌瘤縮小明顯，且原本偏高的紅血球及紅血球分佈寬度，在子宮肌瘤變小後，皆恢復正常。本病例報告顯示在中醫治療下，可以幫助子宮肌瘤縮小，並紀錄罕見的肌瘤性紅血球增生症候群的病例。
英文摘要

Uterine fibroids are one of the common benign tumors in women of reproductive age. This case report presents a 52-year-old female with a history of thrombocytosis caused by Janus kinase2 (JAK2) mutation and a giant uterine fibroid. The patient visited the Traditional Chinese Medicine (TCM) gynecology department at Chang Gung Memorial Hospital in Taoyuan on November 11, 2021, complaining of long-term abdominal distension. The patient had undergone a high-intensity focused ultrasound (HIFU) treatment for uterine fibroid and asked for a combined treatment of TCM to further shrink the fibroid. The TCM diagnosis was blood stasis due to qi stagnation. The treatment strategy was to soothe the liver, disperse stagnation, promote qi circulation, and remove blood stasis, with Citrus reticulata Blanco seed as the main herb. During the first three days of menstruation, Gui Zhi Fu Ling Wan was used as the main formula. After five months of TCM treatment, the patient reported a significant decrease in abdominal distension and a visible reduction in the size of the fibroid. Additionally, the previously elevated red blood cell count (RBC) and red blood cell volume distribution width (RDW) levels returned to normal after the fibroid shrank. This case report suggests that TCM treatments might benefit in shrinking uterine fibroids after HIFU treatment and improve the RBC count in this rare case of fibroid-induced polycythemia.
主题分类 醫藥衛生 > 中醫藥學
参考文献
  1. Uterine fibroids (leiomyomas): Treatment overview. UpToDate.
  2. 中醫婦科學.弘祥出版社.
  3. Uterine fibroids (leiomyomas): Epidemiology, clinical features, diagnosis, and natural history. UpToDate.
  4. Chen, E,Mullally, A(2014).How does JAK2V617F contribute to the pathogenesis of myeloproliferative neoplasms?.Hematology Am Soc Hematol Educ Program,2014(1),268-276.
  5. de Guzman, Glaiza S(2019).Myomatous erythrocytosis syndrome: A case series.Case Reports in Women's Health,24,e00139.
  6. Fennessy, FM,Tempany, CM(2007).Uterine leiomyomas: MR imaging-guided focused ultrasound surgery - results of different treatment protocols.Radiology,243(3),885.
  7. Li, Wei,Mao, Jiayu(2020).Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis.Journal of International Medical Research,48(12),1-9.
  8. Merchant, Salma(2021).The JAK2 mutation.International Review of Cell and Molecular Biology,365,117-162.
  9. Mui, Justin(2020).More Than a Myoma: A Review of Myomatous Erythrocytosis Syndrome.Journal of Obstetrics and Gynaecology Canada,42(2),198-203.e3.
  10. Recker, Florian,Thudium, Marcus(2021).Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids.Scientific Reports,11,22768.
  11. Scott, Linda M(2007).JAK2 exon 12 mutations in polycythemia vera and idiopathic erythrocytosis.The New England Journal of Medicine,356(5),459-468.
  12. Shen, Q,Ye, W,Hu, X(2016).The Effects of Guizhi Fuling Capsule Drug Serum on Uterine Leiomyoma Cells and Its Mechanism.Evid Based Complement Alternat Med,2016,2393640.
  13. Suresh, Pooja(2020).Myomatous Erythrocytosis Syndrome: Case Report and Review of the Literature.The Cureus Journal of Medical Science,12(2),e6892.
  14. Suzuki, M.(2001).Erythropoietin synthesis by tumor tissues in a patient with uterine myoma and erythrocytosis.British Journal of Hematology,113(1),49-51.
  15. Vannucchi, Alessandro M(2013).JAK2 mutation-related disease and thrombosis.Seminars in Thrombosis and Hemostasis,39(5),496-506.
  16. Yen, Hung-Rong,Chen, Ying-Yu,Huang, Tzu-Ping(2015).Prescription patterns of Chinese herbal products for patients with uterine fibroid in Taiwan: A nationwide population-based study.Journal of Ethnopharmacology,223-230.
  17. 台灣婦產科醫學會（編制）(2008)。子宮肌瘤臨床指引。台灣婦產科醫學會編制。民國 97 年 8 月 25 日。
  18. 李坤寅,關永格,王慧穎(2008)。從橘荔散結丸淺析羅元愷教授治療子宮肌瘤經驗。中華中醫藥學刊，26(2)
  19. 高飛霞,羅頌平(2014)。子宮肌瘤合併妊娠治驗舉隅。國際中醫中藥雜誌
print cancel