和胃疗疳颗粒联合他药治疗小儿慢性胃炎的疗效观察

目的:探讨中西医结合治疗小儿幽门螺旋杆菌(HP)相关性慢性胃炎的疗效。方法:采用随机、对照的方法对入选的小儿HP相关性慢性胃炎75例分为中西医结合治疗组42例,对照组33例,两组患者均用阿奇霉素,水杨酸铋治疗,治疗组另加和胃疗疳颗粒口服。治疗12周后,观察厌食缓解,脘腹压痛及临床疗效。结果:治疗后治疗组厌食缓解、脘腹压痛较对照组为优(P<0.05),治疗组总有效率优于对照组(P<0.05)。结论:治疗组加用和胃疗疳颗粒能缓解厌食和缓解脘腹压痛,能提高总有效率。

和胃疗疳颗粒治疗小儿厌食症疗效观察

目的:观察和胃疗疳颗粒治疗小儿厌食症的临床疗效。方法:将70例小儿厌食症患儿随机分成治疗组和对照组,各35例。治疗组口服和胃疗疳颗粒,对照组口服葡萄糖酸锌口服液,4周为1个疗程,观察小儿厌食症患者食欲、食量、精神状态的改善情况。结果:2组患儿食欲、食量及精神状况较治疗前有明显改善,治疗组治愈率为48.6%,有效率为88.6%;对照组分别为28.6%、65.7%。组间比较,2组患儿临床疗效差异有统计学意义(P<0.05)。结论:和胃疗疳颗粒可明显改善小儿厌食症症状,对小儿厌食症有较好的临床疗效。

益气和胃疗疡汤治疗消化性溃疡60例

2001年7月-2006年7月期间，笔者采用自拟益气和胃疗疡汤治疗消化性溃疡60例，并与单纯内服西药治疗的30例作比较，2组疗效及复发率有显著差异，现报道如下。

Hpylori根除加中药疗胃煎剂对鼠慢性胃炎病变影响

目的:评价根除H pylori加疗胃煎剂对大鼠H pylori相关性慢性胃炎病变的影响.同时观察治疗前后环氧合酶-2 (Cyclooxygenase-2,COX-2)表达的变化. 方法:体质量80-100 g二级(?) Wister大鼠80只,采用H pylori及MNNG综合方法制备大鼠H pylori相关性慢性胃炎模型76只,血清H pylori抗体阳性54只随机分为4组:H pylori根除与疗胃煎剂组(14只)、H pylori根除与“麦滋林”组(阳性对照组)(14只)、自然恢复组(阴性对照组)(13只)、单纯H pylori根除组(13只).治疗结束后,行胃窦黏膜涂片Gram染色和快速尿素酶试验,检测H pylori的定植情况,并对胃窦黏膜组织学各项指标进行评定;采用免疫组化染色方法,检测胃窦黏膜的COX-2的表达. 结果:自然恢复组大鼠均有H pylori定植,其他各组大鼠胃黏膜均未发现H pylori定植;自然恢复组的大鼠表现中度萎缩病变(2.0±0.20分),伴有中度急性、慢性炎症(2.0±0.20分、1.90±0.39分);而H pylori根除联用疗胃煎剂组,与自然恢复组比较,萎缩病变(1.25±0.44分)轻度改善,伴急性炎症(0.3±0.47分)消退,慢性炎症(1.05±0.22分)轻度改善,差异显著(P<0.05);H pylori根除与麦滋林组胃窦黏膜层萎缩病理积分为2.0±0.43分,较自然恢复组无明显差异,但急性炎症消退,慢性炎症无改善.单纯H pylori根除组,与自然恢复组比较,萎缩病变和慢性炎症未见改善,但活动性炎症消退;单纯根除H pylori 组、根除H pylori与联用疗胃煎剂组、H pylori根除与麦滋林组、自然恢复组COX-2表达率分别为14.0±3.7%、10.0±3.8%、13.0±4.0%、19.0±10.2%,治疗组与自然恢复组比较,胃窦黏膜COX-2表达率明显下降,差异显著(P<0.05). 结论:对H pylori相关性慢性胃炎,根除H pylori可明显降低COX-2表达,明显改善急性炎症,但对慢性病变尤其萎缩病变无明显影响.根除H pylori的基础上应用疗胃煎剂治疗12 wk有较好的疗效.

金果胃康胶囊治疗胃黏膜异型增生60例临床观察

目的:观察金果胃康胶囊对胃黏膜异型增生(CAP)证属毒瘀交阻、气阴不足的治疗作用。方法:选择明确诊断为CAP证属毒瘀交阻、气阴不足者60例,随机分为两组。治疗组30例给予金果胃康胶囊治疗,对照组30例给予三九胃泰胶囊。两组均以3个月为1疗程,连用2个疗程。结果:治疗组临床有效率90.00%,对照组73.33%,治疗组明显优于对照组(P<0.05)。两组治疗后主要症状积分比较,治疗组优于对照组(P<0.05)。结论:金果胃康胶囊治疗CAP疗效确切,且使用安全。

埃索美拉唑治疗胃食管反流病的临床观察

目的探讨不同剂量埃索美拉唑对胃食管反流病(GERD)的治疗效果。方法选择63例门诊及住院经电子胃镜证实为GERD患者(洛杉矶分级为A级和B级)随机分为三组。A组20例予以埃索美拉唑20mg,每日2次;B组21例予以埃索美拉唑40mg,每日2次;C组22例予以埃索美拉唑20mg,每日2次,睡前40mg,分别观察患者治疗前及治疗后8周临床症状改善情况;治疗8周后行电子胃镜检查观察愈合率。结果三组临床症状均有明显改善,症状记分较治疗前显著下降(P均<0.01)。C组在症状消失率、总有效率以及内镜下食管炎愈合率和总有效率方面均高于A、B组,但差异无显著性。结论埃索美拉唑是治疗轻、中度GERD患者有效的药物,尤其加用夜间酸突破治疗,效果更佳。

XELOX方案治疗老年人晚期胃肠癌20例近期疗效观察

目的 评价XELOX方案治疗老年人晚期胃肠癌的疗效及安全性。方法 20例老年人晚期胃肠癌患者给予希罗达1000mg／m^2，饭后30min口服，2次／d，第1～14天；草酸铂75mg／m^2加入5％葡萄糖注射液250ml中持续滴注2～3h，第1天。3周为1周期，至少完成2个周期。结果 20例患者中，完全缓解（CR）2例，部分缓解（PR）6例，病情稳定（SD）9例，疾病进展（PD）2例，总有效率42．1％。Ⅲ、Ⅳ级不良反应主要为白细胞减少症2例，腹泻1例，手足综合征1例，贫血1例，皮肤色素沉着1例。Ⅰ、Ⅱ级不良反应为皮肤色素沉着8例，腹泻5例，手足综合征5例，白细胞减少症5例。结论 XELOX方案治疗老年人晚期胃肠癌疗效显著，患者耐受性好。

嗜酒前后胃乙醇脱氢酶活性变化机制研究

目的探讨嗜酒前后胃乙醇脱氢酶(ADH)活性的变化机制。方法Wistar大鼠39只随机分成两组:模型组24只,对照组15只,模型组给予乙醇灌胃,对照组用蒸馏水灌胃;用HE病理染色技术和酶组化电镜染色技术,观察给酒前后胃黏膜的细胞及亚细胞结构的变化。结果模型组给酒后,HE病理显示胃粘膜的主细胞、壁细胞等明显肿胀变性,酶组化电镜显示主细胞和壁细胞的内质网和线粒体发生溶解;对照组实验前后未发生上述改变。结论给酒前后胃乙醇脱氢酶活性变化的机制可能是由于胃黏膜的主细胞、壁细胞水肿变性,从而导致其线粒体和内质网变性、溶解有关。

足疗三班

1、胃疗不适 在双脚大脚趾下方，第一块骨头下方的凹陷处，是胃在脚底穴位的反射区。如果你的胃总是出现一些痛、胀、不消化的问题。经常用手摆尖反复用力按压这个穴道。力道以感觉到酸疼为好．久而久之胃部的小毛病会得到较大的改善。

法莫替丁治疗消化性溃疡近期疗效观察

法莫替丁(Famotidine)是一种新的抗消化性溃疡药剂,具有可逆的竞争性拮抗组胺H_2受体作用,抑制胃酸分泌,从而促进溃疡愈合。我们自1989年11月起应用随机双盲法对国产法莫替丁治疗消化性溃疡的近期疗效进行临床观察。现将结果报道如下。

“疗胃煎剂”胃粘膜保护作用的实验研究

目的 :研究“疗胃煎剂”对胃粘膜慢性损伤的防护作用。方法 :应用 2级 Wistar大鼠灌胃接种 SSl Hp菌株 ,灌胃 3%水杨酸钠溶液 ,交替自由饮用 5 %乙醇与 5 m mol/ L 去氧胆酸钠溶液及饥饱失常的综合方法制备 Hp相关 CAG动物模型。模型制备成功后均先行根除 Hp,进行“疗胃煎剂”治疗 ,并以三九胃泰作对照 ,12周疗程结束后 ,进行 Hp感染 ,组织病理学检查及血清 EGF及粘膜氨基己糖含量检测。结果 :“疗胃煎剂”中、高剂量组大鼠胃粘膜固有层、粘膜表面上皮层、PAS(+ )层厚度较模型自然恢复组明显增加 (P <0 .0 1) ,其中粘膜固有层与表面上皮层厚度增加明显优于三九胃泰 (分别 (P <0 .0 5 ) ,已接近正常组水平 (P >0 .0 5 )。“疗胃煎剂”与三九胃泰组均有增加 PAS(+ )层厚度的作用 (P <0 .0 5 )。“疗胃煎剂”中剂量组粘膜氨基己糖含量较模型自然恢复组明显增加 (P <0 .0 5 )。各治疗组血清 EGF浓度均较模型自然恢复组明显下降。结论 :“疗胃煎剂可以增加氨基己糖含量及粘膜表面上皮层厚度 ,具有增强粘膜屏障功能的作用。

Clinical Study of Photodynamic Therapy for Upper Gastrointestinal Tract Cancers

Objective： To evaluate the clinical effectiveness and adverse effects of photodynamic therapy （PDT） for the upper gastrointestinal tract cancers. Methods： 56 patients with upper gastrointestinal cancers in different clinical stages were treated with PDT. Diode laser （630 nm） was used as the light source and the parameters were as follows： power density 200 to 400 mW/cm, energy density 100 to 300 J/cm. PHOTOFRIN was used as photosensitizer, which was given in a dose of 2 mg/kg intravenously 12-24 h before irradiation. Results： Evaluation of the 56 patients＇ therapeutic effectiveness showed that 6 patients （10.7%） had a complete response （CR）, 33 patients （58.9%） partial response （PR）, 12 patients （21.4%） mild response （MR）, and 5 patients （8.9%） no response （NR）. The total response rate （CR＋PR） was 69.6%. No patients had severe adverse effects in this group. Conclusion： PDT is an effective and safe palliative modality for upper gastrointestinal tract cancers.

Public Screening for Early Carcinoma of Gastric Cardia: Rule of Carcinogenetic Development Observed by Endoscopy

Objective： To study the rule of development of early cancer of gastric cardia in vivo in public screening. Methods： A prospective cohort study on gastric cardiac cancer was performed in the high incidence area of cancer of esophagus and stomach in china. 106 subjects had been examined regularly by endoscopy to observe the change of mucosa in high incident area of gastric cardiac carcinoma developing at the root of gastric cardiac ridge by taking biopsy specimen. All specimens were diagnosed through normal pathological process to study the prognosis of pro-cancer lesions of gastric cardia. Results： The results of 106 subjects who had been observed for 4 years were： （1） Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. （2） Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 mild atypical hyperplasia, and 2 highly atypical hyperplasia. （3） Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. （4） Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. （5） One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. （6） Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, and 3 turned to atypical hyperplasia. Conclusion： The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. （2） The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.

Effectiveness and safety of splenectomy for gastric carcinoma:A meta-analysis

AIM： To evaluate the impact of splenectomy on longterm survival, postoperative morbidity and mortality of patients with gastric cancer by performing a metaanalysis METHODS： A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register, Mediine, CBMdisc （Chinese Biomedical Database） and J-STAGE, etc was performed. Data was extracted from the studies by 2 independent reviewers. Outcome measures were survival, postoperative morbidity and mortality and operation-related events. The meta-analyses were performed by RevMan 4.3. RESULTS： Three studies comprising 466 patients were available for analysis, with 231 patients treated by gastrectomy plus splenectomy. Splenectomy could not increase the 5-year overall survival rate [RR = 1.17, 95% confidence interval （CI） 0.97-1.41]. The postoperative morbidity （RR = 1.76, 95% CI 0.82-3.80） or mortality （RR = 1.58, 95% CI 0.45-5.50） did not suggest any significant differences between the 2 groups. No significant differences were noted in terms of number of harvested lymph nodes, operation time, length of hospital stay and reoperation rate. Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer. No obvious differences were observed between the 2 groups when stratified by stage. Sensitivity analyses indicated no significant differences regarding the survival rates （P 〉 0.05）. CONCLUSION： Splenectomy did not show a beneficial effect on survival rates compared to splenic preservation. Routinely performing splenectomy should not be recommended.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

Multidisciplinary management of gastric and gastroesophageal cancers

Carcinomas of the stomach and gastroesophageal junction are among the five top leading cancer types worldwide. In spite of radical surgical R0 resections being the basis of cure of gastric cancer, surgery alone provides long-term survival in only 30% of patients with advanced International Union Against Cancer （UICC） stages in Western countries because of the high risk of recurrence and metachronous metastases. However, recent large phase-Ⅲ studies improved the diagnostic and therapeutic options in gastric cancers, indicating a more multidisciplinary management of the disease. Multimodal strategies combining different neoadjuvant and/or adjuvant protocols have clearly improved the gastric cancer prognosis when combined with surgery with curative intention. In particular, the perioperative （neoadjuvant, adjuvant） chemotherapy is now a well-established new standard of care for advanced tumors. Adjuvant therapy alone should be carefully discussed after surgical resection, mainly in individual patients with large lymph node positive tumors when neoadjuvant therapy could not be done. The palliative treatment options have also been remarkably improved with new chemotherapeutic agents and will further be enhanced with targeted therapies such as different monoclonal antibodies. This article reviews the most relevant literature on the multidisciplinary management of gastric and gastroesophageal cancer, and discusses future strategies toimprove Iocoregional failures.

Predictive value of MTT assay as an in vitro chemosensitivity testing for gastric cancer:One institution's experience

AIM:To investigate the predictive clinical value of in vitro 3-(4,5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay for directing chemosensitivity in patients with gastric cancer. METHODS:Results of a total of 353 consecutive patients with gastric cancer treated with MTT-directed chemotherapy or physician’s empirical chemotherapy from July 1997 to April 2003 were reviewed and analyzed retrospectively. RESULTS:The overall 5-year survival rate of MTT- sensitive group (MSG) and control group (CG) was 47.5% and 45.1%, respectively. The results of subgroup analysis with Cox proportional-hazards model were favorable for the MSG-sensitive group. However, no statistically significant difference in survival rate was observed between the two groups. CONCLUSION:Individualized chemotherapy based on in vitro MTT assay is beneficial, but needs to be confirmed by further randomized controlled trials.

Epidermal growth factor receptor antibody plus recombinant human endostatin in treatment of hepatic metastases after remnant gastric cancer resection

We report a 55-year-old male who developed advanced hepatic metastasis and peritoneal carcinomatosis after resection of remnant gastric cancer resection 3 mo ago. The patient only received epidermal growth factor (EGF) receptor antibody (Cetuximab) plus recombinant human endostatin (Endostar). Anti-tumor activity was assessed by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) at baseline and then every 4 wk. The case illustrates that 18FDG-PET/CT could make an early prediction of the response to Cetuximab plus Endostar in such clinical situations. 18FDG-PET/CT is a useful molecular imaging modality to evaluate the biological response advanced hepatic metastasis and peritoneal carcinomatosis to Cetuximab plus Endostar in patients after remnant gastric cancer resection.

Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy

AIM： To assess the efficacy of metoclopramide （Met） for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy （IPC）. METHODS： Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation （group A）, and 16 did not （group B）. Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group （group C）. All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization. RESULTS： Gender, the type of resection, operating time, blood loss, tumor status and amount of narcotics were comparable in the three groups. However, the group C patients were older than those in groups A and B （67.5±17.7 vs 56.8±13.2, 57.5±11.7 years, P= 0.048）. First bowel flatus occurred after 4.35±0.93 d in group A, 4.94±1.37 d in group B, and 4.71±1.22 d in group C （P〉0.05）. Oral feeding of a sore diet was tolerated 7.21±1.92 d after operation in group A, 10.15±2.17 d in group B, and 7.53±1.35 d in group C （groups A and C vsgroup B, P〈0.05）. There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantlyshorter than that in group B patients. Levels of C-reactive protein （CRP） were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met. CONCLUSION： The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC. Furthermore, the administration of Met did not increase anastomotic leakage. Met has a role in the prevention of prolonged post-operative ileus.

Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis

AIM: To report a case of severe idiopathic gastroparesis in complete absence of Kit-positive gastric interstitial cells of Cajal (ICC). METHODS: Gastric tissue from a patient with severe idiopathic gastroparesis unresponsive to medical treatment and requiring surgery was analyzed by conventional histology and immunohistochemistry. RESULTS: Gastric pacemaker cells expressing Kit receptor had completely disappeared while the local level of stem cell factor, the essential ligand for its development and maintenance, was increased. No signs of cell death were observed in the pacemaker region. CONCLUSION: These results are consistent with the hypothesis that a lack of Kit expression may lead to impaired functioning of ICC. Total gastrectomy proves to be curative.