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Exploración de la evolución patogénica de la transformación inflamatoria a cancerígena en el esófago de Barrett y estrategias de interrupción en medicina tradicional china basadas en "dos nodos – tres etapas"

  • 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

resumen

El esófago de Barrett (BE) es un estado precanceroso del adenocarcinoma esofágico. El mecanismo de transformación inflamatoria a cáncer es complejo y clínicamente carece de medios efectivos para revertir o detener dicho proceso, lo que representa un desafío en la prevención y el tratamiento. Este estudio aborda el problema clave de la dificultad para interrumpir la progresión de la enfermedad durante la transformación inflamatoria a cáncer en el BE, basándose en la teoría de "prevenir cambios tras la enfermedad", proponiendo de manera innovadora un sistema patogénico de "dos nodos – tres etapas". Nuestro equipo considera que la causa inicial del BE es la estasis del qi hepático, donde los dos nodos críticos en la evolución patológica son la estasis del qi hepático y la transformación de la estasis en calor, mientras que la estasis, la transformación en calor y la formación de estasis constituyen las tres etapas evolutivas de la enfermedad. Además, el reflujo de sales biliares ácidas actúa como un "tóxico" que atraviesa todo el proceso y cataliza la carcinogénesis. Basándonos en esto, nuestro principio de tratamiento general es "tratar desde el hígado y cortar la progresión", enfatizando la intervención por etapas: en la etapa de estasis de qi se utiliza la terapia para dispersar el hígado, regular el qi, suavizar y bajar, seleccionando la fórmula Chaihu Shugansan combinada con Xuanfudaizhetang, usando con precaución sustancias picantes y secantes, asistidas con productos florales ligeros y refrescantes; en la fase de transformación en calor el tratamiento es para aclarar el hígado, eliminar el calor, proteger el yin y el estómago, usando la fórmula Huaganjian combinada con Yiguanjian, añadiendo Jinlingzi San y otros para drenar el fuego estancado; en la fase de formación de estasis el tratamiento es para activar la sangre, disolver la estasis, fortalecer lo correcto y desintoxicar, usando la fórmula Gexiazhuyutang combinada con Liujunzi Tang, agregando moderadamente Danshen, Biejia y otros para dispersar nódulos y aliviar síntomas. Este sistema teórico construye un marco de diagnóstico y tratamiento que combina patogenia y patología, macro y micro perspectivas, proporcionando una vía práctica clínica completa de teoría, método y fórmula para interrumpir por etapas la transformación inflamatoria a cáncer en BE según la medicina tradicional china.

palabra clave

esófago de Barrett; transformación inflamatoria a cáncer; tratamiento desde el hígado; interrupción y reversión; dos nodos – tres etapas

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