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Exploration de l'évolution pathogenique de la transformation inflammatoire en cancer de l'œsophage de Barrett et des stratégies d'interruption en médecine chinoise basées sur "deux nœuds – trois phases"

  • role： First author第一作者
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

  • Introduction：王晓，女，在读博士生
WANG Xiao,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

SHI Bin,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

HE Cong,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

XU Xinyu,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

KONG Jing,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

CHENG Chuanqi,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

YU Meng,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

FAN Shumiao,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

YU Bangsheng,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

ZHU Shengliang,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

ZHOU Bingduo,  
  • Affiliation：

    Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

  • Email：xswangxs0084@163.com
  • Introduction：通信作者：王晓素，女，博士，教授，主任医师，博士生导师，主要研究方向：中西医结合防治消化系统疾病，E-mail：xswangxs0084@163.com
WANG Xiaosu

résumé

L'œsophage de Barrett (BE) est un état précancéreux de l'adénocarcinome œsophagien. Le mécanisme de transformation inflammatoire en cancer est complexe et il manque actuellement des moyens cliniques efficaces pour inverser ou interrompre ce processus, ce qui constitue un défi dans la prévention et le traitement. Cette étude vise à aborder la difficulté clé d'interrompre l'évolution de la maladie lors de la transformation inflammatoire en cancer dans le BE, en s'appuyant sur la théorie de la "prévention des changements post-maladie" et en proposant de manière innovante un système pathogénique "deux nœuds – trois phases". Notre équipe considère que le BE a pour cause initiale la stagnation de Qi hépatique. Les deux nœuds clés de l'évolution de la maladie sont la stagnation de Qi hépatique qui se transforme en chaleur, alors que la stagnation de Qi, la transformation en chaleur et la formation de stase forment les trois phases d'évolution de la maladie. De plus, le reflux de sels biliaires acides constitue un "toxique" traversant tout le processus et catalysant la carcinogenèse. Sur cette base, notre équipe applique le principe général "traiter à partir du foie, interrompre et inverser" en insistant sur une intervention par stade. À la phase de stagnation de Qi, le traitement vise à apaiser le foie, réguler le Qi, adoucir et abaisser, avec la formule Chaihu Shugansan combinée à Xuanfudaizhetang, en évitant prudemment les agents épicés et asséchants, accompagnée de plantes florales légères et rafraîchissantes; à la phase de transformation en chaleur, le traitement consiste à clarifier le foie, évacuer la chaleur, protéger le yin et l’estomac, utilisant la formule Huaganjian combinée à Yiguanjian, avec l'ajout de Jinlingzisand pour dissiper la chaleur stagnante; à la phase de formation de stase, le traitement consiste à activer le sang, dissoudre la stase, renforcer le juste et détoxifier, avec la formule Gexiazhuyutang combinée à Liujunzi Tang, avec des ajouts modérés de Danshen, Biejia et autres pour disperser les masses et atténuer les symptômes. Ce système théorique établit un cadre de diagnostic et de traitement combinant pathogenèse et pathologie, macro et micro perspectives, offrant une voie pratique clinique complète avec des théories, méthodes et formules pour interrompre la transformation inflammatoire en cancer du BE selon la médecine chinoise.

mots-clés

œsophage de Barrett; transformation inflammatoire en cancer; traitement hépatique; interruption et inversion; deux nœuds – trois phases

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