| Objectives: Gastric cancer is one of the most common malignancies.In 2018,there will be about 1.033 million new cases(1/18)of gastric cancer worldwide,and about 783,000 deaths(1/12),ranking 5th in the incidence of malignancy and 2nd in the mortality.In China,there are 400,000 cases of gastric cancer every year,accounting for 42% of the world’s cases,and about 300,000 deaths,seriously threatening people’s health.Up to now,surgical resection is still the only curable method for gastric cancer,but thesurgery itself also brings about a series of problems,the most prominent of which is the postoperative gastrointestinal motility insufficiency inevitably brought by the surgical trauma stress itself and the gastrectomy and gastrointestinal reconstruction.The role of traditional Chinese medicine(TCM)in postoperative gastric cancer is receiving more and more attention and playing an important role.The purpose of this study was to observe the effect of QiHuang Decoction(QH)on the recovery of gastrointestinal function after gastric cancer surgery.The mechanism of qi huang decoction on the recovery of gastrointestinal function was further studied.The gastric resection animal model of Wistar rats was established through surgical trauma,followed by the intervention of dropping the traditional Chinese medicine qihuang decoction in the small intestine,to observe the effect of QH on the gastrointestinal function of rats after gastric resection.To investigate the mechanism of QH on gastrointestinal function recovery.Methods:clinical observation: Source: data of 128 patients with confirmed gastric cancer admitted to our hospital from January 2010 to December 2018 were selected.Control group: patients received routine surgical treatment after surgery.Observation group:on the basis of the control group,small intestine infusion of astragalus decoction was given on the first day after surgery.The recovery time of bowel sounds,anal exhaust time and defecation time of patients in each group were recorded.Conduct statistical analysis of the results.Animal experiments: modeling and grouping methods: A total of 60 rats,29 males and 31 females,with a mass of(360±20)g,were randomlydivided into 4 groups,including control group,sham operation group,standard enteral nutrition group(EN)and standard enteral nutrition + astragalus decoction group(EN+QH).Intervention methods for each group: Control group: no treatment,free drinking and eating,no enteral nutrition and Chinese medicine.In the sham group,only midsection of the abdomen was performed and sutured,not gastrectomy.Free drinking and eating after surgery,without enteral nutrition and traditional Chinese medicine.Standard enteral nutrition group: gastric resection was performed and standard enteral nutrition was given.EN+QH group was given another 5g/(kg.d)of astragalus decoction.Observation index method: two months after modeling,the rats’ small intestine electrophysiology and propulsion rate were detected after treatment.The expression of SCF and c-kit protein was determined by ELISA.The number and structure of ICC cells were observed by transmission electron microscopy.Statistical methods: All measurement data were expressed as mean standard deviation((?)±s).Single factor analysis of variance(AVOVA)was used to compare the above data between the two groups,and SPSS 23.0 software was used for processing.P<0.05 was considered statistically significant.Results: clinical observation results:the recovery time of intestinal rumble in the observation group(46.75±8.69h),and that in the control group(53.05±10.63h),was significantly higher than that in the control group(P=0.034).The first exhaust time in the observation group(50.28±7.02h)and the control group(60.48±10.32h)was significantly higher than that in the control group(P=0.025).The first bowel movement time(55.75±9.82h)in the observation group and the bowel sounds time(65.05±10.13h)in the control group were significantly higher than those in the control group(P=0.046).There was no significant difference in the incidence of complications between the control group and the observation group(P>0.05).Animal experiment results: It was found that qihuang decoction could change the electrophysiological movement of small intestine in rats after gastrectomy.The intestinal propulsion rate of rats in the normal group was66.2±3.8%.The intestinal propulsion rate of the sham group was 63.5±4.6%.The intestinal propulsion rate of the standard nutrition group was 32.5±4.0%.Theintestinal propulsion rate of the standard nutrition + TCM group was 40.5±3.7%.Compared with the standard nutrition group,the intestinal propulsion rate of the standard nutrition + traditional Chinese medicine group was significantly increased(P=0.034).These results showed that qihuang decoction can significantly improve the small intestine propulsion ability of rats after gastrectomy.Compared with the normal group,the intestinal propulsion rate of the standard nutrition + TCM group was significantly reduced(P=0.002).Compared with the sham group,the enteral propulsion rate was significantly reduced in the standard nutrition + TCM group(P=0.003).Through transmission electron microscopy,the morphology of ICC cells was changed in the standard nutrition + TCM group compared with the nutritional group.By ELISA determination of SCF and C-kit protein expression of normal group in the rat small intestine SCF protein concentration was 2011.00 ± 169.88pg/ml,SCF protein concentration in the control group was 1742.83±183.71 pg/ml,standard and fewer ten patients experienced septic complicationsSCF protein concentration was 1206.33±129.83 pg/ml,and fewer ten patients experienced septic complications + Chinese traditional medicine group of SCF protein concentration is1436.58±206.74 pg/ml,compared with the standard and fewer ten patients experienced septic complications,standard and fewer ten patients experienced septic complications + Chinese traditional medicine group could significantly increase the concentration of SCF(P=0.014);Compared with the normal group,the SCF concentration in the standard nutrition group and the traditional Chinese medicine group decreased significantly(P<0.001).Compared with the sham group,the SCF concentration in the standard nutrition group and the traditional Chinese medicine group decreased significantly(P=0.001).In the normal group,the concentration of c-kit protein was 2045.97±169.87pg/ml;in the sham group,the concentration of c-kit was 1701.25±88.62pg/ml;in the standard nutrition group,the concentration of c-kit protein was 1330.41±127.23pg/ml;in the standard nutrition group,the concentration of c-kit was 1561.66±205.69pg/ml.Compared with the normal group,the concentration of c-kit in the standard nutrition group and the traditional Chinesemedicine group decreased significantly(P<0.001).Compared with the sham group,the concentration of c-kit in the standard nutrition group and the traditional Chinese medicine group decreased significantly(P=0.032).The positive area of c-kit in the normal group was 182.04±10.15,the positive area of c-kit in the sham group was166.06±14.19,the positive area of c-kit in the standard nutrition group was 119.37±17.21pg/ml,and the positive area of c-kit in the standard nutrition group +traditional Chinese medicine group was 143.49±16.83.Compared with the normal group,the positive area of c-kit in the standard nutrition group and Chinese medicine group decreased(P<0.001).Compared with the sham group,the positive area of c-kit in the standard nutrition group and Chinese medicine group decreased(P<0.001).Conclusions: through clinical observation,it was found that the application of small intestine infusion of traditional Chinese medicine qihuang decoction in postoperative patients with gastric cancer can promote the recovery of gastrointestinal function.Animal experiments:(1)qi huang decoction can promote the recovery of intestinal motor function by improving the electrophysiological movement of gastrointestinal and small intestine after gastrectomy in rats;(2)qihuang decoction can improve ICC network structure after gastrectomy in rats;(3)qi huang decoction can improve the expression of SCF and c-kit protein and restore the number of ICC cells.(4)qi huang decoction can improve the expression of c-kit protein and restore the number of ICC cells. |
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