近端胃大部切除术后早期肠内营养的临床应用

目的探讨胃上部癌患者行近端胃大部切除术后早期肠内营养的方法及临床效果。方法选择2016年3月—2018年3月行近端胃大部切除术的患者79例,随机分为观察组40例和对照39例,分别给予肠内营养(EN)和肠外营养(PN),随后对比两组住院时间、营养支持费用、排气时间、排便时间、前白蛋白、血清白蛋白、体重、氮平衡。结果 EN组肛门排气(46.7±6.1)h、排便时间(65.6±5.5)h、住院时间(11.4±2.1)d均较PN组明显缩短,差异有统计学意义(t=18.100 3、27.700 2、7.733 1;P<0.05),营养支持费用(349.3±43.6)元/d,EN组较PN组亦明显降低(t=35.362 8;P<0.05)。结论近端胃大部切除术后患者早期肠内营养可促进术后早期消化道功能的恢复。

Identification of bioactive anti-angiogenic constitutes targeting tumor endothelial cells in Shenmai Injection using multidimensional pharmacokinetics

OBJECTIVE To identify the bioactive anti-angiogenic constitutes targeting tumor endothelial cells(TECs)in Shenmai Injection(SMI).METHEODS For pharmacokinetic(PK)studies,Balb/c mice harboring human colorectal cancer(LoVo)xenografts were treated with SMI 10 mL·kg^-1 daily for 1 or 8 d.Multidimensional PK profiles of ginsenosides in plasma,subcutaneous tumors,and TECs were investigated.For PD studies,the tumor-bearing mice Intravital multi-photon imaging and CD31 immunofluorescence staining were used to evaluate the number of microves⁃sels and braches.Double staining of CD31 and α-SMA was performed to evaluate pericytes coverage ratios around vessels.ELISA was performed to determine the concentrations of VEGF and FGF in tumor tissues.For synergistic anti-tumor study,the tumor-bearing mice were treated with SMI 10 mL·kg^-1 daily,Rd 5 mg·kg^-1 daily with or without 5-FU 15 mg·kg^-1 every 3 d for 20 d.HPLC-MS/MS was used to determine the concentrations of 5-FU in plasma and tumor tissues.RESULTS SMI decreased the number of microvessels(P<0.05)and vessel branches(P<0.05)and improved vascular pericytes coverage(P<0.05).PK studies showed that the concentrations of protopanaxadiol-type(PPD)ginsenosides(Rb1,Rb2/Rb3,Rc,and Rd)in both,plasma and tumors,were higher than those of protopanaxatriol-type(Rg1 and Re)and oleanane-type(Ro)ginsenosides.Among PPD ginsenosides,Rd exhibited the greatest concentrations in tumors and TECs after repeated injection.In fact,the proportion of Rd in the detectable components of SMI gradually increased in the following order:SMI formula(2.8%),plasma(16.0%),tumor tissues(34.3%),and TECs(40.3%).In vivo bioactivity results showed that Rd 5 mg·kg^-1 daily significantly decreased the number of microvessels(P<0.05)and vessel branches(P<0.05)and increased pericytes coverage(P<0.05)while Rd 0.5 mg·kg^-1 daily,Rb1 and Rg1 had no significant effect on them.Rd 5 mg·kg^-1 suppressed the expression of VEGF and FGF simultaneously.Rd 5 mg·kg^-1 enhanced the antitumor effect of 5-FU via increasing the distribution of 5-FU in tumor tissues(P<0.05)in xenograft mice.CONCLUSION Ginsenoside Rd may be the major bioactive anti-angiogenic constituent targeting TECs after SMI treatment.

刘沈林辨治胃癌术后经验撷菁

刘沈林为南京中医药大学附属医院前院长,南京中医药大学副校长,全国第四批、第五批名老中医药专家学术经验继承指导老师,全国名中医,临床上主要从事消化系肿瘤的中医诊疗,尤其在胃肠道肿瘤的中医诊疗方面积累了丰富的临床经验。他认为脾胃虚弱是胃癌术后的主要病机,而正气不足则是其病因。而在诊疗时善于将辨证与辨病相结合,以健脾胃为总的治疗原则,在治疗中重视扶助人体的正气,疗效颇佳。

黄芪四君子汤增强进展期胃癌术前辅助化疗敏感性的临床研究

目的:探讨黄芪四君子汤对进展期胃癌术前辅助化疗敏感性的影响及其可能机制。方法:选取2017年1月至2018年6月在江苏省中医院消化肿瘤外科接受2个疗程术前辅助化疗的进展期胃癌患者60例,随机分为对照组(28例)和中药组(32例)。对照组仅接受辅助化疗,中药组接受辅助化疗和黄芪四君子汤治疗。应用美国癌症联合委员会肿瘤退缩分级判断化疗效果。检测患者外周血清及组织标本中IL-8表达情况,并分析化疗敏感性的影响因素。结果:中药组化疗敏感19例(59.38%),对照组化疗敏感8例(28.57%),中药组显著高于对照组(P<0.05)。手术前中药组患者IL-8水平显著低于对照组(P<0.05);中药组中化疗敏感患者胃癌组织IL-8表达水平低于化疗耐药患者。影响进展期胃癌患者化疗敏感性的因素有Lauren分型、中药辅助治疗及血清IL-8水平。结论:黄芪四君子汤可能通过降低胃癌患者外周血清IL-8水平增强术前辅助化疗敏感性。

影响胃癌合并2型糖尿病患者术后血糖水平的相关因素分析

目的探讨影响胃癌合并2型糖尿病患者术后血糖水平的相关因素,从而为手术时更好地选择消化道重建方式及控制术后血糖水平提供参考依据。方法回顾性分析南京中医药大学附属医院消化系肿瘤外科2008年1月-2018年12月收治的179例胃癌合并2型糖尿病患者的临床资料,对可能影响术后血糖水平的临床因素通过χ^2检验进行单因素分析,P<0.05则为相关因素,再对相关因素进行二元logistic回归分析,P<0.05则为独立影响因素。结果 179例胃癌合并2型糖尿病患者均完成了胃癌根治性切除手术,其中有4例患者手术后糖尿病治愈,122例术后糖尿病缓解,术后血糖水平改善的有效率为70.39%(126/179)。通过单因素分析显示年龄、有无冠心病、术前糖尿病治疗方式、是否切除全胃、有无胆胰分流袢、糖尿病病程以及术前空腹C肽水平与术后血糖水平相关,进一步进行二元logistic回归分析,显示有无胆胰分流袢、糖尿病病程及术前空腹C肽水平是胃癌合并2型糖尿病患者术后血糖水平的独立影响因素。结论分析结果显示有无胆胰分流袢、糖尿病病程及术前空腹C肽水平是胃癌合并2型糖尿病患者术后血糖水平的独立影响因素,临床上对于糖尿病病程较短,术前空腹C肽水平大致正常的患者,手术时通过胆胰分流的消化道重建方式可以更好地改善术后血糖水平。