Function-preserving gastrectomy for gastric cancer in Japan

Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to functionpreserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer(EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements:(1) reduction of the extent of gastrectomy;(2) preservation of the pylorus; and(3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in functionpreserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.

Assessment of proximal gastric accommodation in patients with functional dyspepsia

Impaired gastric accommodation is one of the most important etiologic factors in the pathophysiology of functional dyspepsia.Ultrasound is a potential alternative method to study changes in gastric volume as a reflection of gastric accommodation.Ultrasound is suitable for patients because it is a non-invasive,easily repeated and non-radioactive procedure,and a previous study has demonstrated the feasibility of 3-dimensional ultrasound in examining functional dyspepsia.The brief article by Fan et al demonstrated that both the proximal gastric area and volume,measured by 2-and 3-dimensional ultrasound respectively,were significantly smaller in patients with functional dyspepsia than in healthy controls.These results are very interesting,but we raise the relevant point that it should have been mandatory to study both changes in gastric volume and their relationship with upper gastrointestinal symptoms in functional dyspepsia.In fact,the relationship between cardinal symptoms and several pathophysiologic mechanisms in functional dyspepsia remains a matter of debate.Moreover,further evaluation of distal gastric volume that has been previously implicated in the origin of functional dyspeptic symptoms is advisable.Therefore,impaired gastric accommodation does not serve as a clear marker of the cardinal symptoms experienced by patients with functional dyspepsia in daily life.

Current status of function-preserving surgery for gastric cancer

Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer(GC)at an early stage.Due to the low incidence of lymph node metastasis and favorable prognosis in early GC,function-preserving surgery which improves postoperative quality of life may be possible.Pylorus-preserving gastrectomy(PPG)is one such function-preserving procedure,which is expected to offer advantages with regards to dumping syndrome,bile reflux gastritis,and the frequency of flatus,although PPG may induce delayed gastric emptying.Proximal gastrectomy(PG)is another functionpreserving procedure,which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach,although the incidence of heartburn or gastric fullness associated with this procedure is high.However,these disadvantages may be overcome by the reconstruction method used.The other important problem after PG is remnant GC,which was reported to occur in approximately 5%of patients.Therefore,the reconstruction technique used with PG should facilitate postoperativeendoscopic examinations for early detection and treatment of remnant gastric carcinoma.Oncologic safety seems to be assured in both procedures,if the preoperative diagnosis is accurate.Patient selection should be carefully considered.Although many retrospective studies have demonstrated the utility of function-preserving surgery,no consensus on whether to adopt functionpreserving surgery as the standard of care has been reached.Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.

Itopride for gastric volume,gastric emptying and drinking capacity in functional dyspepsia

AIM To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia(FD). METHODS Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ^(13) C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink was checked using satiety drinking capacity test. Theintervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTS Mean age of the recruited participant 33 years(SD = 7.6) and most of the recruited individuals, i.e., 21(67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach(P = 0.14), at 20 min(P = 0.38), 30 min(P = 0.30), 40 min(P = 0.43), 50 min(P = 0.50), 60 min(P = 0.81), 90 min(P = 0.25) and 120 min(P = 0.67). Gastric emptying done on a sub sample(n = 11) showed no significant difference(P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo(P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score(P = 0.74). The change in QT interval in itopride group was not significantly different from placebo(0.10). CONCLUSION Our study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.

Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance

AIM: To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer. METHODS: We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and alkaline phosphatase were measured on the preoperative day and postoperative day 1 (POD1), POD3, POD5, and POD7. RESULTS: No changes in liver function were observed after the operation in patients with colon cancer (n = 121). However, in gastric cancer patients (n = 215), AST and ALT levels increased until POD5 compared to those in colon cancer patients and these findings were observed both in the LAG and OG without a significant difference except at POD1. The mean hepatic enzyme levels at POD1 in the LAG group were significantly higher than those in the OG group (P = 0.047 for AST and P = 0.039 for ALT). The factors associated with elevated ALT on POD1 in patients with gastric cancer were body mass index (P < 0.001), operation time (P < 0.001), intraoperative hepatic injury (P = 0.048), and ligation of an aberrant left hepatic artery (P = 0.052) but not type of operation (OG vs LAG, P = 0.094). CONCLUSION: We conclude that the liver function alteration after LAG may have been caused by direct liver manipulation or aberrant hepatic artery ligation rather than the CO2 pneumoperitoneum.

Relationship between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in functional dyspeptic patients

AIM: Delayed gastric emptying and an enlarged fasting gastric antrum are common findings in functional dyspepsia but their relationship with gastrointestinal (GI), and the frequently associated extra-GI symptoms remains unclear.This study evaluated the relationship between GI and extra-GI symptoms, fasting antral volume and delayed gastric emptying in functional dyspepsia.METHODS: In 108 functional dyspeptic patients antral volume and gastric emptying were assessed with ultrasonography (US). Symptoms were assessed with standardized questionnaire. The association of symptoms and fasting antral volume with delayed gastric emptying was estimated with logistic regression analysis.RESULTS: Delayed gastric emptying was detected in 39.8% of the patients. Postprandial drowsiness (AOR 11.25; 95%CI 2.75-45.93), nausea (AOR 3.51; 95%CI 1.19-10.32), fasting antral volume (AOR 1.93; 95%CI 1.22-3.05), were significantly associated with delayed gastric emptying. Symptoms, mainly the extra-GI ones as postprandial drowsiness and nausea, combined with fasting antral volume predicted the modality of gastric emptying with a sensitivity and specificity of 78%.CONCLUSION: In functional dyspeptic patients, (1) an analysis of fasting antral volume and of symptoms can offer valuable indication on the modality of gastric emptying,and (2) it seems appropriate to inquire on postprandial drowsiness that showed the best correlation with delayed gastric emptying.

Autonomic functions and gastric motility in children with functional abdominal pain disorders

BACKGROUND Abdominal pain-predominant functional gastrointestinal disorders(AP-FGIDs)are the most common cause of recurrent abdominal pain in children. Despite its high prevalence, the underlying pathophysiology of this condition is poorly understood.AIM To assess the role of gastric dysmotility and autonomic nervous system dysfunction in the pathophysiology of AP-FGIDs.METHODS One hundred children, fulfilling Rome III criteria for AP-FGIDs, and 50 healthy controls, aged 5 to 12 years, were recruited after obtaining parental consent. All patients were investigated for underlying organic disorders. Gastric motility and cardiovascular autonomic functions were assessed using validated non-invasive techniques.RESULTS The main gastric motility parameters assessed(gastric emptying rate [45.7 vs 59.6 in controls], amplitude [48.7 vs 58.2], frequency of antral contractions [8.3 vs 9.4],and antral motility index [4.1 vs 6.4]) were significantly lower in children with AP-FGIDs(P < 0.05). The post-prandial antral dilatation at 1 min after the test meal significantly correlated with the severity of abdominal pain(P < 0.05).Assessment of autonomic functions in AP-FGID patients showed neither a significant difference compared to the control group, nor a correlation with gastric motility abnormalities(P > 0.05). The duration of pain episodes negatively correlated with the parasympathetic tone(maladaptive parasympathetic tone)(P< 0.05).CONCLUSION Children with AP-FGIDs have abnormal gastric motility but normal cardiovascular autonomic functions. There is no relationship between abnormal gastric motility and autonomic functions. The pathogenesis of AP-FGIDs is not related to cardiovascular autonomic dysfunction.

Gastrointestinal hormone abnormalities and G and D cells in functional dyspepsia patients with gastric dysmotility

AIM: To investigate the relationship between gastric dysmotility,gastrointestinal hormone abnormalities, and neuroendocrine cells in gastrointestinal mucosa in patients with functional dyspepsia (FD).METHODS: Gastric emptying was assessed with solid radiopaque markers in 54 FD patients, and the patients were divided into two groups according to the results, one with delayed gastric emptying and the other with normal gastric emptying. Seventeen healthy volunteers acted as normal controls. Fasting and postprandial plasma levels and gastroduodenal mucosal levels of gastrointestinal hormones gastrin, somatostatin (SS) and neurotensin (NT)were measured by radioimmunoassay in all the subjects.G cells (gastrin-producing cells) and D cells (SS-producing cells) in gastric antral mucosa were immunostained with rabbit anti-gastrin polyclonal antibody and rabbit anti-SS polyclonal antibody, respectively, and analyzed quantitatively by computerized image analysis.RESULTS: The postprandial plasma gastrin levels, the fasting and postprandial plasma levels and the gastric and duodenal mucosal levels of NT were significantly higher in the FD patients with delayed gastric emptying than in those with normal gastric emptying and normal controls. The number and gray value of G and D cells and the G cell/D cell number ratio did not differ significantly between normal controls and the FD patients with or without delayed gastric emptying.CONCLUSION: Our findings suggest that the abnormalities of gastrin and NT may play a role in the pathophysiology of gastric dysmotility in FD patients, and the abnormality of postprandial plasma gastrin levels in FD patients with delayed gastric emptying is not related to the changes both in the number and gray value of G cells and in the G cell/D cell number ratio in gastric antral mucosa.

Laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer: A retrospective study of long-term functional outcomes and quality of life

BACKGROUND Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was known to have benefits of function-preserving surgery compared to laparoscopy-assisted distal gastrectomy (LADG). However, in clinical settings, delayed gastric emptying and esophageal reflux following LAPPG can be serious issues, making surgeons reluctant to perform LAPPG. It is unclear that LAPPG had better longterm functional outcomes and quality of life compared to LADG. AIM To evaluate the long-term functional outcomes and patient-reported quality of life of LAPPG compared to those of LADG. METHODS We reviewed the clinicopathological data of 195 patients who underwent LADG with Billroth II anastomosis and 101 patients who underwent LAPPG for cT1N0 gastric cancer in the middle third of the stomach between 2012 and 2015. Postoperative complications, nutritional parameters, and survey results of the European Organization for Research and Treatment of Cancer Questionnaire C30 and STO22 questionnaire were compared between the two groups. RESULTS The serum hemoglobin level was significantly higher in the LAPPG group than in the LADG group (P < 0.001). In the endoscopic findings, incidence of bile reflux was lower (P < 0.001);however, the incidence of residual food was higher in the LAPPG group than in the LADG group (P < 0.001). Regarding the quality of life score, the LAPPG group had a better physical functioning score (86.7 vs 90.0, P = 0.032) but also greater pain and reflux when compared to the LADG group [8.3 vs 16.7 in pain, 11.1 (interquartile range, 0, 22.2) vs 11.1 (interquartile range, 11.1, 33.3) in reflux, P = 0.034 and 0.001, respectively]. CONCLUSION LAPPG is beneficial to recovery of anemia and to bile reflux, however, it might be unfavorable in terms of pain and reflux symptoms compared to LADG with Billroth II anastomosis.

Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia

AIM: To assess the value of ultrasonography (US) in evaluation of proximal gastric accommodation disorder in patients with functional dyspepsia (FD). METHODS: Between April 2011 and March 2012, 45 patients with FD and 27 healthy volunteers were enrolled in this study. Two-dimensional ultrasound (2DUS) and 3-dimensional ultrasound (3DUS) were performed sequentially to measure proximal gastric area (PGA), maximal proximal gastric diameter (MPGD), and proximal gastric volume (PGV). These values were measured separately in the two groups every other 5 min for a duration of 25 min after the beginning of ingestion of a test meal. Air pocket grading was done separately for images of 2DUS and blocks of 3DUS obtained at five scanning time points. RESULTS: Both PGA and PGV of patients were significantly smaller than healthy controls (P = 0.000 and 0.002, respectively). Comparing the two parameters between the groups at each time point, the differences were also statistically significant (P = 0.000-0.013), except at 10 min for the PGV (P = 0.077). However, no overall difference was found between the groups in the MPGD measurements (P = 0.114), though it was statistically significant at a 20-minute examination point (P = 0.026). A total of 360 sets or blocks of images were obtained for both 2DUS and 3DUS. For the images analyzed by 2DUS, none were excluded because of gastric gas, and 50 (13.9%) and 310 (86.1%) sets were determined as air pockets grades 1 and 2, respectively. For the images analyzed by 3DUS, 23 (6.4%) blocks were excluded from the measurement due to presence of a large fundus air pocket (grade 3); fifty (13.9%) and 287 (79.7%) blocks were also graded as 1 and 2, respectively. CONCLUSION: Measurement of both PGA and PGV by 2DUS and 3DUS could be useful for assessment of the proximal gastric accommodation.

Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer

Objectives: To clarify the optimal length of the antral cuff (LAC) in patients after pylorus-preserving gastrectomy (PPG), we investigated relationships between LAC and postgastrectomy disorder (PGD) such as postprandial abdominal fullness (PAF), and between LAC and gastric empting function (GEF) in PPG patients. Background: The main cause of PGD in PPG patients has been considered to be LAC. Relationships between LAC and PGD and GEF in PPG patients are still unknown. Methods: Of 50 patients who underwent PPG in our hospital from January 2001 to December 2015 were divided into 2 groups [Group A, short LAC of 1.5 to 2.5 cm (n = 24);Group B, long LAC of 2.6 to 3.5 cm (n = 26)]. The relationships among LAC, PGD, and GEF were retrospectively studied. Results: LAC was clearly shorter in group A than group B (P < 0.01). PAF, appetite and food consumption per meal were clearly more favorable in group B than in group A (P < 0.01, respectively). Symptomatic reflux esophagitis (RE), early dumping syndrome, decreased percent body weight for pre-illness, endoscopic RE and endoscopic gastritis in the remnant stomach were more frequent in group A than group B. Gastric stasis in the remnant stomach was clearly more frequent in group A than group B (P < 0.01). GEF with the solid diet in group A was clearly more delayed than in group B (P Conclusions: Patients with a short LAC showed worse postoperative QOL and delayed GEF with the solid diet compared with a long LAC.

Effect of Chaihu Shugan decoction on gastric smooth muscle cell apoptosis in rats with functional dyspepsia

Objective:To investigate the effect of Chaihu Shugan decoction(CSD)on gastric smooth muscle cells(GSMCs)apoptosis in rats with functional dyspepsia(FD).Methods:48Sprague-Dawley(SD)rats were randomly assigned into six groups:a normal control group,a model group,apositive control(domperidone)group and low-,middle-and high-dose CSD groups.A rat model of FD was established by constantly squeezing their tails.The rats were administered CSD(0.16g/mL,0.32g/mL,0.64g/mL)or domperidone(0.3 g/L)via intragastric gavage for four weeks.The gastric emptying rate was detected at 4 weeks post-administration.Apoptosis of GSMCs was determined by terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining and the mitochondrial morphology was observed by transmission electron microscopy.The expression of Bcl-2and Bax was measured by immunohistochemistry.Results:FD resulted in marked reduction of gastric emptying rate,severe gastric tissue damage and mitochondria injury,but were reversed by CSD treatment(P<0.05).The apoptosis-induced protein Bax was markedly down-regulated by CSD,whereas the expression of the anti-apoptotic Bcl-2 protein was notably increased(P<0.05).Furthermore,CSD could protect the FD rats against GSMCs apoptosis manifested by a decreased in TUNEL-positive cells(P<0.05).Conclusion:CSD could alleviate GSMCs apoptosis in FD rats,possibly by the modulation of Bcl-2 and Bax expression,and the suppression of mitochondria injury.

Effect of ginger Effect of ginger on gastric motility and symptoms of functional dyspepsiaon gastric motility and symptoms of functional dyspepsia

AIM:To evaluate the effects of ginger on gastric motility and emptying,abdominal symptoms,and hormones that influence motility in dyspepsia.METHODS:Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner.After an 8-h fast,the patients ingested three capsules that contained ginger(total 1.2 g) or placebo,followed after 1 h by 500 mL low-nutrient soup.Antral area,fundus area and diameter,and the frequency of antral contractions were measured using ultrasound at frequent intervals,and the gastric half-emptying time was calculated from the change in antral area.Gastrointestinal sensations and appetite were scored using visual analog questionnaires,and blood was taken for measurement of plasma glucagon-like peptide-1(GLP-1),motilin and ghrelin concentrations,at intervals throughout the study.RESULTS:Gastric emptying was more rapid after ginger than placebo [median(range) half-emptying time 12.3(8.5-17.0) min after ginger,16.1(8.3-22.6) min after placebo,P ≤ 0.05].There was a trend for more antral contractions(P = 0.06),but fundus dimensions and gastrointestinal symptoms did not differ,nor did serum concentrations of GLP-1,motilin and ghrelin.CONCLUSION:Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia,but had no impact on gastrointestinal symptoms or gut peptides.

Study of Gastric and Gallbladder Kinetics with Real－time Ultrasonography in Cases of Functional Dyspepsia

Gastric and gallbladder emptying in 113 patients with functional dyspepsia (FD) were evaluated by real-time ultrasonography (RUS) after a liquid-fat meal by the patients, and compared with 15 healthy volunteers. The results showed that in FD group 69 patients (61. 06%) had delayed gastric emptying,and 28 patients (24.77%) had gallbladder hypokinesia. Among them both delayed gastric ernptying and gallbladder hypokinesia were found in 11 patients (9.7%), 44 patients (38.93%)had normal gastric emptying and 85 patients (75.22%) had normal gallbladder emptying.

耳穴揿针对改善胃癌根治术后患者胃肠功能及营养状况的效果

目的探讨耳穴揿针对胃癌根治术后患者胃肠功能及营养状况的影响。方法选取2021年6月—2022年3月江苏省中医院接受胃癌根治术的68例患者为研究对象,按照组间基本特征具有可比性的原则分为观察组与对照组,每组34例。对照组患者予以常规护理,观察组患者在此基础上接受耳穴揿针疗法,两组患者干预3天,对比其胃肠功能恢复情况、术后第3天的胃肠道不良反应、术后第7天的机体营养状况。结果观察组患者术后肠鸣音恢复时间、首次排便时间短于对照组,组间比较差异有统计学意义(P<0.05);两组患者术后首次排气时间比较差异无统计学意义(P>0.05)。观察组患者术后第3天腹胀、恶心呕吐发生率低于对照组,组间比较差异有统计学意义(P<0.05)。术前1 d,两组患者的血清总蛋白(TP)、前白蛋白(PA)比较差异无统计学意义(P>0.05);术后7 d,两组TP水平比较差异无统计学意义(P>0.05),但观察组患者PA水平高于对照组,组间比较差异有统计学意义(P<0.05)。结论耳穴揿针可以促进胃癌术后患者肠鸣音恢复,缩短首次排便时间,有效降低胃癌根治术后患者恶心、呕吐及腹胀的胃肠道不良反应发生率,提高术后患者机体营养水平,从而提升生活质量,促进术后康复。

经皮穴位电刺激术联合君子消痞汤改善糖尿病胃轻瘫的作用及机制研究

目的观察经皮穴位电刺激术(TEAS)联合君子消痞汤治疗糖尿病胃轻瘫(DGP)的疗效,探讨其作用机制。方法64例确诊的DGP患者为研究对象,采用临床试验中央随机系统将其随机分为A组、B组、C组、D组,每组16例。A组:TEAS治疗4周后,洗脱2周,常规治疗4周;B组:君子消痞汤治疗4周后,洗脱2周,常规治疗4周;C组:TEAS+君子消痞汤治疗4周后,洗脱2周,常规治疗4周;D组:常规治疗4周后,洗脱2周,TEAS+君子消痞汤治疗4周。比较四组患者治疗前后生活质量[健康调查简表(SF-36)中的躯体性功能(PF)、角色受限(RE)、社会功能(SF)、心理健康情况(MH)、角色生理情况(RP)、活力/精力(V)、身体疼痛(BP)、综合健康情况(GH)]、胃排空功能[胃半排空时间(T_(1/2))及120 min胃内食物残留率]、疗效,分析四组患者安全性。结果四组患者治疗后PF、MH、V、BP及GH评分均较治疗前明显升高,差异有统计学意义(P<0.05);四组患者治疗后RE、SF、RP评分与治疗前比较差异无统计学意义(P>0.05)。与A组、B组治疗后相比,C组、D组患者治疗后PF、MH、V、BP及GH评分更高,差异有统计学意义(P<0.05)。四组患者治疗后T_(1/2)、120 min胃内食物残留率均较治疗前显著下降,差异有统计学意义(P<0.05)。与A组、B组患者治疗后相比,C组、D组患者治疗后T_(1/2)更短,120 min胃内食物残留率更低,差异有统计学意义(P<0.05)。四组患者总有效率分别为56.25%、62.50%、93.75%和93.75%。与A组、B组相比,C、D组治疗总有效率明显较高,差异有统计学意义(P<0.05);A组与B组、C组与D组患者总有效率相比,差异无统计学意义(P>0.05)。四组患者均能坚持治疗至疗程结束,均未见明显不良反应。各组在临床观察中,治疗前后血尿常规、大便常规、肝肾功能、血生化及心电图等各项检查指标均无明显改变。结论采用TEAS联合君子消痞汤治疗DGP可显著提高其生活质量,改善胃排空功能,提高疗效,效果优于单独应用TEAS或君子消痞汤。

健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响研究

目的 探究健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响。方法 收集我院2019年6月—2022年6月肿瘤科收治的晚期胃癌患者95例,随机分为对照组(47例)与试验组(48例)。对照组予以FOLFOX4方案进行化疗,试验组在对照组的基础上予以健脾养胃法。两组均治疗9周,治疗结束后比较2组中医症状积分、血清肿瘤标志物、免疫功能指标、治疗期间胃肠道反应、远期生存率。结果 治疗后与对照组相比,试验组临床有效率较高(P<0.05)。治疗后与治疗前相比2组脘腹痞闷、胸胁胀痛、食欲缺乏、便溏及神疲乏力等中医症状积分降低;与对照组相比,试验组所有中医症状积分均较低(P<0.05)。治疗后与治疗前相比2组CEA、CA12-5、CA19-9及CA72-4降低;与对照组相比,试验组CEA、CA12-5、CA19-9及CA72-4较低(P<0.05)。治疗后与治疗前相比2组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)升高,IgG、IgM降低(P<0.05);与对照组相比,试验组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)较高,IgG、IgM较低(P<0.05)。2组6个月及1年生存率相比无统计学意义(P>0.05);试验组3年内生存率高于对照组(P<0.05)。结论 健脾养胃法应用于老年胃癌晚期胃癌患者的治疗中近远期治疗效果显著,能提高免疫功能,下调肿瘤标志物水平,适宜临床应用。

心理弹性在老年胃癌术后患者认知功能和睡眠障碍间的中介效应

目的探讨心理弹性在老年胃癌术后患者认知功能和睡眠障碍之间的中介效应。方法采用便利抽样的方法,随机抽取河北医科大学第四医院外三科246例老年胃癌术后患者。使用一般资料调查量表、匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)、心理弹性量表(Connor-Davidson resilience scale,CD-RISC)和简易智能精神状态量表(Mini-mental State Examination,MMSE)分别调查老年胃癌术后患者的睡眠质量、心理韧性和认知功能。结果PSQI、CD-RISC和简MMSE得分分别为(5.63±1.41)、(60.31±7.85)和(17.56±2.97)分,PSQI总分与MMSE评分、CD-RISC总分呈负相关(R值分别为-0.421、-0.542,P<0.05),MMSE总分与CD-RISC总分呈正相关(R=0.874,P<0.05),线性回归分析结果显示心理弹性在认知功能和睡眠障碍之间起部分中介作用,贡献率为71.28%。结论认知功能通过心理弹性间接影响老年胃癌术后患者的睡眠质量,老年胃癌术后患者的睡眠质量和认知功能有待进一步提高。

莫沙必利联合奥美拉唑镁对反流性食管炎患者胃分泌功能、血清Ghrelin、Leptin水平的影响

目的探讨莫沙必利联合奥美拉唑镁对反流性食管炎患者胃分泌功能、血清人生长素释放多肽(Ghrelin)、瘦素(Leptin)水平的影响作用。方法回顾性选取2022年2月~2023年2月泸县人民医院诊治的180例反流性食管炎患者,根据治疗方案分为奥美拉唑镁组(n=86)和联合用药组(n=94)。奥美拉唑镁组使用奥美拉唑镁肠溶片进行治疗,联合用药组在奥美拉唑镁组的基础上联合枸橼酸莫沙必利片进行治疗。比较两组患者的临床疗效;比较两组患者胃分泌功能[胃泌素(GAS)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃动素(MOT)、血管活性肠肽(VIP)]变化情况;比较两组患者血清Ghrelin和Leptin水平;比较两组患者治疗期间不良反应情况。结果联合用药组的总有效率(94.68%)显著高于奥美拉唑镁组的总有效率(81.40%),差异有统计学意义(χ^(2)=7.692,P<0.05)。治疗后,两组患者PGⅡ、VIP、Leptin水平显著低于治疗前,且联合用药组PGⅡ、VIP、Leptin水平明显低于奥美拉唑镁组[(14.85±1.73)μg L vs.(21.51±2.11)μg L、(13.41±1.27)pg ml vs.(20.45±1.15)pg ml、(8.11±1.13)pg ml vs.(16.52±2.73)pg ml],差异有统计学意义(t=23.236、38.857、27.416,P<0.05)。治疗后,两组患者GAS、PGⅠ、MOT、Ghrelin水平明显高于治疗前,且联合用药组GAS、PGⅠ、MOT、Ghrelin水平明显高于奥美拉唑镁组[(96.85±5.81)pg ml vs.(78.76±4.87)pg ml、(132.71±11.26)μg L vs.(120.42±10.84)μg L、(280.24±21.67)pg ml vs.(200.56±17.62)pg ml、(26.46±3.41)pg ml vs.(19.64±3.85)pg ml],差异有统计学意义(t=22.527、7.446、26.915、12.602,P<0.05)。治疗期间两组不良反应差异无统计学意义(χ^(2)=1.738,P>0.05)。结论莫沙必利联合奥美拉唑镁治疗反流性食管炎患者临床效果显著,安全性比较好,可以有效改善胃分泌功能,调节血清Ghrelin、Leptin水平平衡,进而改善反流现象,具有良好的临床应用价值。

胃复春对不同NLR水平的胃早癌ESD术后患者的消化道症状、胃肠激素、胃功能指标和血常规指标的影响

背景胃复春可治疗内镜下剥离术(endoscopic submucosal dissection,ESD)后的胃早癌患者,中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)可作为评估此类患者活动度和预后的指标.目前尚未确定不同NLR水平的ESD术后胃早癌患者是否存在与之相关的胃复春疗效差异.目的探讨胃复春对不同NLR水平的胃早癌ESD术后患者的治疗效果.方法选取本院2020-01/2022-12收治的160例胃早癌ESD术后患者,将其分为常规治疗组(n=40)和常规治疗+胃复春治疗组(n=120).将胃复春治疗组再按照NLR水平进行三分位分组,分为高三分位组(NLR≥3.23)40例,低三分位组(NLR≤1.74)40例,中三分位组(NLR:1.74-3.23)40例.比较以上各组治疗前后的主要的消化道症状评分、胃肠激素水平、胃功能指标及血常规指标水平,并计算治疗的总有效率.结果与治疗前比较,治疗后各组患者的胃脘灼热、胃脘胀满、胃脘疼痛和胃纳呆滞评分均降低(P<0.05),其中以低三分位组治疗效果最佳(P<0.05),总有效率最高(P<0.05).常规治疗不能改变患者NLR与血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)水平,而常规治疗+胃复春治疗能降低患者的NLR与PLR水平(P<0.05).治疗后,与常规治疗组比较,胃复春治疗组(低、中和高三分位组)的抑胃肽、胃动素、胃泌素、胃蛋白酶原Ⅰ和胃蛋白酶原比值水平均增高(P<0.05)、白细胞、胃蛋白酶原Ⅱ和癌胚抗原均降低(P<0.05),其中以低三分位组最为明显.结论胃复春在不同NLR水平的胃早癌ESD术后患者中均显示出改善消化道症状、胃肠激素、胃功能指标和血常规指标的作用,尤其对于低NLR水平患者而言,治疗效果最为显著.在选择治疗方法时,建议优先考虑低NLR水平的胃早癌ESD术后患者使用胃复春进行治疗.