◇◇新语丝(www.xys.org)(xys4.dxiong.com)(www.xinyusi.info)(xys2.dropin.org)◇◇ 为中医垫背说谎，吴孟超你如何教导后人？ 作者：王澄 在XXX的领导下，科学家都变成了伪科学家。前有大科学家钱学森证明能 “亩产万斤粮”，鼓吹气功和中医，武汉的裘法祖支持肖传国拿中国人作伪 科学实验，又有中华医学会会长钟南山为中医背书，说“看到北京两个治疗H1N1 中药的研究(数据)，我很服气。”今天又跳出个外科老家伙吴孟超说“西医治疗 注重局部，而中医重视整体，两者结合优势互补，相得益彰。如今在肿瘤治疗当 中，中医已经不再是辅助治疗，而是肿瘤的常规治疗手段。所以，中西医结合可 以提高肝癌的疗效。” 请问吴孟超老先生，你说的“中西医结合可以提高肝癌的疗效”的科学实验 报告在哪里？这种实验研究在国际上什么地方被重复过？你是88岁的人了，快死 了还给中医垫背。你和钱学森裘法祖一样，多年来摸出了一个道理，想要在科学 上保持永久性权威，就要在政治上保持一贯正确。60年来，你们混淆了科学和政 治的基本概念，88岁时已经糊涂到不知道自己什么时候是为政治说话，什么时候 是为科学说话。 你的这种屁话“中西医结合可以提高肝癌的疗效”是对中国医学科学的最大 的侮辱和背叛。 我在这里带你读一下英文eMedicine里对原发性肝癌Primary Hepatic Carcinoma的处理原则。我这样作是想让你回答大家一个问题，你说的“中西医 结合可以提高肝癌的疗效”和国际上对原发性肝癌的处理原则的区别在哪里？如 何证明这个区别能够“提高疗效”？ 中医现在是两头说谎，一头是不用治就好的病，比如流感；另一头是治了也 不好的病，比如肝癌。中医的办法是作东郭先生，“参与了，结果说不清”。除 了这两头的病，那些治了就有救，不治就要坏事的病，中医早就被踢出去了。 88岁的吴孟超临死前还要无视科学根据，为中医垫背说谎，把你祖先的脸都 丢尽了。吴孟超你如何教导后人？ 原发性肝癌死亡率和并发症Mortality/Morbidity Cure, usually through surgery, is possible in fewer than 5% of all patients.通过手术治愈的不到5％。Median survival from time of diagnosis is generally 6 months. 存活一般是6个月。Length of survival depends largely on the extent of cirrhosis in the liver; cirrhotic patients have shorter survival times and more limited therapeutic options; portal vein occlusion, which occurs commonly, portends an even shorter survival.影响存活的主要因素是肝硬化和门静脉堵塞。Complications from hepatocellular carcinoma are those of hepatic failure; death occurs from cachexia, variceal bleeding, or (rarely) tumor rupture and bleeding into the peritoneum.并发症由肝衰产生，死亡原因有恶病质，静脉 曲张出血，或肿瘤破裂出血。 Medical Care药物治疗包括系统化疗Systemic chemotherapy Surgical Care手术治疗包括部分肝切除Partial hepatectomy，肝移植 Transplantation，局部肿瘤剥离Local tumor ablation。 Available treatment options depend on the size, number, and location of tumors; presence or absence of cirrhosis; operative risk based on extent of cirrhosis and comorbid diseases; overall performance status; patency of portal vein; and presence of metastatic disease. Before instituting definitive therapy, it is best to treat the complications of cirrhosis with diuretics, paracentesis for ascites, lactulose for encephalopathy, ursodiol for pruritus, sclerosis or banding for variceal bleeding, and antibiotics for spontaneous bacterial peritonitis.在定义性治疗前，最好先用利尿剂处理肝硬化并发症， 穿刺抽腹水，治疗脑病，治疗搔痒，用硬化和绑紮治疗静脉曲张出血，用抗菌素 治疗细菌性腹膜炎。 Follow-up Further Outpatient Care随访和门诊处理 Monitor the progression of disease or adequacy of treatment with imaging studies every 2-3 months and LFTs and AFP monthly or as appropriate for the stage of disease and patient's performance status. These interventions, however, have little or no impact on prognosis for survival and therefore should be performed in accordance with the patient's functional status. Deterrence/Prevention避免/预防 Patients should avoid alcohol and other hepatic toxins because prognosis is related to worsening cirrhosis and tumor stage.病人不要喝 酒和吃对肝脏有毒性的东西。 Complications并发症 Symptoms of hepatic failure may signify tumor recurrence and/or progression.肝衰的症状 Prognosis预后 Overall prognosis for survival depends on the extent of cirrhosis and tumor stage, 预后主要依赖肝硬化程度和肿瘤的早/晚分期which then determine the appropriate treatment. Patients able to undergo a curative resection have a median survival of as long as 4 years; patients who present when they are too ill to be treated have a median survival of 3 months. Patient Education病人教育 Medicolegal Pitfalls有关事项 Consider hepatocellular carcinoma in any person with possible risk factors who develops symptoms of liver disease, such as unexplained jaundice, increased abdominal girth, or pruritus.有肝病症状的比如黄疸， 腹围增加，搔痒的病人要排除肝癌。 Family members of patients with hepatitis B infections should undergo screening for the virus.乙肝病人的家人要查乙肝。 Consider screening of patients with cirrhosis, especially those with hepatitis C infection.肝硬化者要排除肝癌。 Special Concerns特别注意 Screening for hepatocellular carcinoma排查肝癌 Despite the widespread use of screening and surveillance programs for hepatocellular carcinoma, the efficacy and cost-effectiveness of screening programs for at-risk patients is unclear.目前认为，肝癌排查 工作的效/价比并不明确。 In general, the annual incidence of developing hepatocellular carcinoma in the setting of cirrhosis is approximately 1-4%. Screening studies have shown that, although lesions may be discovered at an earlier stage, the lack of curative treatment options in patients with cirrhosis may not lead to improvements in survival.每年有1-4％ 的肝硬 化病人发展成肝癌。经管能早期发现，但有肝硬化的病人的存活期并不改善。 Patients with chronic hepatitis B without cirrhosis have a much lower annual incidence of developing hepatocellular carcinoma of 0.46%. 乙肝病人如果没有合并肝硬化发展成肝癌的每年是0.46%，比有肝硬化病人少很 多。The incidence of hepatocellular carcinoma in patients with chronic hepatitis C without cirrhosis is even lower. 丙肝病人如果没有合并肝硬 化发展成为肝癌的机会更低。Screening programs using AFP and an imaging modality in patients with hepatitis B or C without cirrhosis is not cost-effective given the low incidence of hepatocellular carcinoma in these patients and the high cost of imaging techniques. Survival advantage with screening in these at-risk populations has not been demonstrated. The retrospective screening studies that have shown modest survival advantages are confounded by lead-time and length-time bias. If screening is to be undertaken, AFP should not be used alone as a screening test. Instead, AFP should be combined with an imaging modality (ultrasonography, CT scan) to improve sensitivity and specificity. 附录：健康报20091231 中医应是肿瘤常规治疗手段 中国科学院院士、第二军医大学上海东方肝胆外科医院院长吴孟超教授提出： “肝癌是一个全身性疾病在肝脏本身的局部表现。西医治疗注重局部，而中医重 视整体，两者结合优势互补，相得益彰。如今在肿瘤治疗当中，中医已经不再是 辅助治疗，而是肿瘤的常规治疗手段。所以，中西医结合可以提高肝癌的疗效。” 他是在近日由第二军医大学东方肝胆外科医院主办、北京伟达中医肿瘤医院承办 的“肝癌中西医综合治疗论坛”上讲这番话的。 第二军医大学上海东方肝胆外科医院杨甲梅、程树群、曲增强、罗明教授， 上海复旦大学附属肿瘤医院中西医结合科主任刘鲁明教授，中华中医药学会肿瘤 分会副主任委员郑伟达教授等专家，就中西医综合治疗肝癌在论坛上展开讨论。 郑伟达教授认为，肿瘤是全身性疾病，治疗肿瘤要发挥中医药优势，坚持心疗、 药疗、食疗、体疗四位一体综合治疗。杨甲梅教授说，他本人是纯西医，从多年 临床经验发现，中医药的确能对患者实施调理并提高耐受手术能力，手术后则可 促进肝功能恢复。（董文杰） (XYS20100102) ◇◇新语丝(www.xys.org)(xys4.dxiong.com)(www.xinyusi.info)(xys2.dropin.org)◇◇