| Malignant tumors(ie,cancer)are major public health problems in China and even in the world.Malignant bowel obstruction is one of the common complications in cancer patients,with an average survival time of <4 months.The most effective treatment for malignant bowel obstruction is surgery,but most patients are unacceptable due to poor constitution during the late course of the disease,postoperative recurrence of adhesions in the abdominal cavity,or age and long-term treatment.Traditional medical conservative treatments,such as fasting,gastrointestinal decompression and infusion,anti-infection,etc.,have a long time,poor efficacy,and the condition is not alleviated.Long-term treatment of patients who cannot tolerate surgery and other treatments are not effective can lead to worsening of the disease,systemic or local inflammatory reactions such as intestinal perforation,sepsis,bacteremia and peritonitis,and electrolyte imbalance.In the early stage of the study,when we observed the use of ultrasound therapy to treat cancer patients with abdominal tumors,we found that the symptoms of intestinal obstruction were alleviated.Ultrasound therapy is a convenient operation,non-invasive,nontoxic and side effects,and has good tolerance and adaptability to a wide range of people.It can also be used for the elderly who are weak,intolerant or unsuitable for surgery.Therefore,in this study,the ultrasound therapy instrument that has been used in clinical practice is used as an intervention method,and the animal model of colon malignant bowel obstruction and clinical malignant bowel obstruction are studied.The feasibility and effectiveness of ultrasound radiation in relieving malignant bowel obstruction are discussed.Sex,in order to provide a safe,non-invasive,simple and effective method for relieving malignant bowel obstruction in patients with malignant bowel obstruction,to prevent further deterioration of the disease,improve the quality of life of patients with advanced and terminal malignant bowel obstruction,and reduce the quality of the family and The burden of society.Methods1.Establishment of a mouse model of colon malignant bowel obstructionIn the experiment,75 BALb/c mice were randomly divided into three groups: control group,model group and sham operation group,with 25 groups in each group.Model group: After the mice were anesthetized and laparotomized,the mouse CT26 colon cancer cells were injected into the descending colon of the mouse to form a tumor first,and then the intestinal obstruction was further formed to establish an animal model of colon malignant bowel obstruction.Sham-operated group: except for the replacement of mouse CT26 colon cancer cells with normal saline,the rest were performed with the same surgical procedure as the model group;the control group: no treatment.The mice were measured daily for food intake,defecation volume,and body weight.At 0day,6 days,12 days,18 days,and 24 days,5 rats were anesthetized in each group.After measuring the abdominal circumference,the intestines were observed openly,and The circumference of the upper intestine was measured,and the intestinal tissue of the model section was taken for HE staining,and finally the mice were sacrificed.By observing and comparing the three groups of mice’s food intake,defecation volume,body weight,abdominal circumference,upper circumference of the intestine,tumor formation,to evaluate the establishment of the model.2.Experimental study on ultrasound alleviate mouse model of colon malignant bowel obstructionGroups of experimental animals:(1)treatment group: ultrasonic treatment group 1,ultrasonic treatment group 2,respectively,18 days after modeling,continuous treatment withultrasound radiation for 2d,4d,10min/d.(2)Model group: Model group 1,Model group 2,continued to observe 2d,4d after 18 days after modeling.(3)Control group: control group 1,control group 2,no modeling and no treatment,only the same period of observation,10 micein each group.The effects of ultrasonic radiation on the model mice were analyzed bymeasuring the food intake,defecation volume,body weight,abdominal circumference,uppercircumference of the intestine and the distribution and expression of i NOS and c-kit in the upperpart of the model.3.Clinical trial study of ultrasound to alleviate malignant bowel obstructionThe subjects were enrolled in patients with malignant bowel obstruction who were admitted to the Oncology Department of Taizhou People’s Hospital from May 2017 to March 1919.Patients who meet the inclusion criteria but do not meet the exclusion criteria were randomly divided into treatment group and control group.The control group received conventional supportive treatment.The treatment group received conventional therapy plus ultrasound,complete patient history and treatment history,and recorded abdominal pain,bloating,nausea,vomiting,KPS score,fart and defecation in the patients who were enrolled daily before and during the treatment cycle.Results1.Establishment of a mouse model of colon malignant bowel obstructionThe food intake,defecation volume,body weight,abdominal circumference,and the upper circumference of the model were consistent with the control group,and there was no significant difference during the observation period(P>0.05).The food intake and fecal volume of the model group were lower than that of the control group and the sham operation group at 12 days,15 days,18 days,21 days,and 24 days after modeling,and the difference was statistically significant(P<0.05).The body weight of the control group and the sham operation group was significantly higher than that of the model group at 12 days,15 days,18 days,21 days,and 24 days,and the difference was statistically significant(P<0.05).After 12 days,18 days,and 24 days after modeling,abdominal circumference and the upper circumference of the intestine of the model group were larger than those of the control group and the sham operation group,and the differences were statistically significant(P<0.05).HE staining was performed on the colonic region of the mouse model segment,the results showed that tumor cell infiltration occurred in the mouse model group 12 days after modeling,however,there was no lesion in the colon of the sham operation group and the control group,indicating that the colon site was successfully implanted.In summary,the trends of the indicators in the control group and the sham operation group were basically the same,indicating that the process of modeling surgery had little effect on mice.Compared with the control group and the sham-operated group,the model group showed signs of decreased food intake,decreased bowel circumference,and intestinal obstruction in the upper part of the model.The bowel formation was effective and the tumor was able to survive.The animal model of colon malignant bowel obstruction was successfully established.2.Experimental study on ultrasound alleviate mouse model of colon malignant bowel obstruction2.1 Ultrasound alleviate the effect of colonic malignant bowel obstructionThe model rats was irradiated by ultrasound,with ultrasonic irradiation time(days)increased,the amount of food intake and defecation of the mice in the ultrasound treatment group showed an upward trend.The food intake and feces discharge in the treatment group were significantly higher than those in the model group compared with the corresponding observation time,and the difference was statistically significant(P<0.05).Similarly,The abdominal circumference and modeling office the upper circumference of the intestine were significantly smaller than those in the model group compared with the corresponding observation time,the difference was statistically significant(P<0.05).However,after 2d and 4d treatment,the difference in body weight between the treatment group and the model group is not obvious,the difference was not statistically significant(P>0.05).2.2 Distribution and expression of i NOS and c-kit in modeling office the upper circumference of the intestine malignant bowel obstruction before and after ultrasound treatmentAfter ultrasonic treatment for 2d and 4d,with the increase of ultrasonic irradiation time(days),the expression of c-kit in the upper part of the mice in each US treatment group gradually decreased.Compared with the corresponding observation time,the expression of c-kit in the upper part of the model of colon malignant bowel obstruction model was significantly increased(P<0.05).On the contrary,after treatment for 2d and 4d,as the ultrasonic time(days)increased,the expression of i NOS in the colon of the upper part of the mice in each US treatment group gradually decreased.The expression of i NOS in the upper part of the treatment group was significantly lower than that of the control group,the difference was statistically significant(P<0.05).It indicated that the expression of c-kit in the upper intestine of the treatment group gradually increased after sonication,while the expression of i NOS decreased gradually.It is suggested that ultrasound can alleviate cancerous intestinal obstruction,which may be related to the decrease of intestinal inhibitory neurotransmitter NO and the recovery of ICC in intestinal pacemaker cells.3.Clinical trial results of ultrasound in the treatment of malignant bowel obstructionFrom May 2017 to March 2019,the Department of Oncology at Taizhou People’s Hospital met the inclusion criteria.A total of 113 participants were enrolled in the trial.59 patients in the control group and 54 patients in the treatment group.Four of the patients withdrew from the trial due to exacerbations.A total of 109 data were collected,including 54 in the treatment group and 55 in the control group.Repeated measurements of abdominal pain,bloating,nausea,vomiting,and KPS scores were analyzed using a multi-level model,indicating that the treatment group compared with the control group,the treatment group with the treatment time(days)increased,abdominal pain,bloating,nausea,vomiting symptoms gradually reduced,however,the KPS score gradually increased.The situation of exhaust and defecation in the control group and the treatment group was no statistically significant(P>0.05),after treatment,the control group and the treatment group was statistically significant(P<0.01).After one cycle of ultrasound treatment,in the treatment group,there were 10 cases of complete remission,32 cases were improved,6cases were stable,6cases were ineffective,and the effective rate was 88.89%;in the control group,2 cases were completely relieved,9 cases were improved,16 cases were stable,28 cases were ineffective,and the effective rate was 49.1%.There was a statistically significant difference in the distribution of efficacy between the control group and the treatment group(P<0.01).It is suggested that ultrasound can effectively relieve the symptoms of intestinal obstruction in patients with cancerous intestinal obstruction.Conclussion1.Compared with the control group and the sham operation group,it indicates that the model group meets the criteria for successful modeling,indicating that the model is successfully established.2.After ultrasound irradiation,treatment group intestinal obstruction was relieved,and the positive expression of i NOS in the colon tissue of the upper intestinal tract was decreased,and the positive expression of c-kit was increased.The mitigation may be related to the reduction of the intestinal inhibitory neurotransmitter NO content by ultrasound,which is related to the ICC recovery activity of intestinal pacemaker cells.3.Compared with the control group,the treatment group gradually decreased the symptoms of abdominal pain,bloating,nausea and vomiting with the increase of treatment time(days),while the KPS score gradually increased.The number of patients with ventilation and laxation in the treatment group after ultrasound treatment was higher than that in the control group.The efficacy of the treatment group was more effective than the control group.control group after treatment,and the difference was statistically significant.The efficacy of the treatment group was more effective than the control group. |
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