| Advanced gastric cancer (the advanced gastric carcinoma, AGC) because of its high morbidity and mortality is regarded as a threat to our people healthy common digestive tract malignant tumor, the current radical surgery is still the only thing that can effect a radical cure of advanced gastric cancer treatment in the first place.But when clinical practice, some visits have missed the chance to be radical surgery, some patients even completed the radical resection, often due to tumor recurrence and metastasis of treatment failure.Therefore, the progress of neoadjuvant chemotherapy for gastric carcinoma (neoadjuvant chemotherapy, NAC) concept was put forward and gradually began to widely used in clinical.Neoadjuvant chemotherapy can shrink tumors, remove existing small metastases to reduce preoperative tumor staging, improve the radical resection rate and reduce postoperative local recurrence rate.In 2009 the NCCN gastric cancer clinical practice guidelines suggest that incorporate advanced gastric cancer treatment object.At present from the perspective of organization pathology and molecular biology research of advanced gastric cancer cell damage reported more, less use of ultrastructure observation of cell damage related research.Ultrastructure of Angle of advanced gastric cancer cell structure change and the curative effect of new adjuvant chemotherapy for advanced gastric cancer, to guide the new adjuvant chemotherapy is better applied to clinical has a certain significance.New adjuvant chemotherapy in this study adopts two kinds of chemotherapy approaches, namely the interventional chemotherapy and intravenous chemotherapy.In addition, it is not difficult to find that to accept the new adjuvant chemotherapy after the Pathological complete response (Pathological complete remission, pCR) cases, follow-up treatment for this type of cases are controversial at present.In this study the first two parts based on this idea for the design of clinical research, using to verify the advantages of interventional chemotherapy compared with intravenous chemotherapy and to discuss whether the cases of pathological complete remission need further treatment.Chemotherapy is shrinking, kill tumor at the same time can also lead to many complications, and more clinical to nausea and vomiting, bone marrow suppression, liver and kidney dysfunction and abnormal peripheral nerve and related adverse reaction of chemotherapy, nausea and vomiting (CINV) is also one of the most common adverse reactions, severe cases can lead to preoperative treatment early, this to improve the overall treatment of advanced gastric cancer cases influential effect, the third part of this study for postoperative adjuvant chemotherapy induced nausea and vomiting adverse reactions in clinical observation, the method of using the spleen nourishing the stomach party oral, explore the spleen and nourishing the stomach party the prevention and treatment of nausea and vomiting caused by chemotherapy curative effect and mechanism of action, in order to provide reference for clinical prevention and treatment of nausea and vomiting caused by chemotherapy and guidance.Part Ⅰ Advanced gastric cancer cell ultrastructure change after neoadjuvant chemotherapy and cancerous tissue SATB1 expressionObjective:Phase by observing the progress of the changes of the ultrastructure of gastric cancer cells after neoadjuvant chemotherapy and carcinoma tissue SATB1 expression, to explore new adjuvant chemotherapy for gastric cancer cell damage mechanism, and the relationship between the ultrastructural changes and SATB1.Methods:Into between December 2012 and December 2012,60 cases of patients with advanced gastric cancer, including 20 cases who accepted interventional chemotherapy and intravenous chemotherapy to the 20 cases, direct surgical treatment as control group 20 cases, postoperative gastric cancer tissue and tissue adjacent to carcinoma in ultrastructure under electron microscope observation, and testing the new adjuvant chemotherapy before and after gastric cancer tissue and tissue adjacent to carcinoma SATB1 immunohistochemical expression.Results: ②Good cells in the tissue of the postoperative pathological reaction in organelles of the serious damage, a nuclear pyknosis, mitochondria and endoplasmic reticulum swelling, poor reaction cell organelles no damage or injury. ②Cellular damage to accept the new adjuvant chemotherapy was significantly higher than that of control group (P<0.05), intervention chemotherapy to cell damage degree is higher than cases of intravenous chemotherapy (P=0.047), various types of damage are statistically significant. ③SATB1 in ultrastructure damage obvious expression of the more obvious, the difference has statistical significance (P=0.040).Conclusions:The damage degree of interventional chemotherapy for advanced gastric cancer cells from vein, and increases the damage to the cell nucleus.SATB1 expression related to tumor infiltrating degree, SATB1 can be used as evaluation of neoadjuvant chemotherapy is effective.Part Ⅱ Advanced gastric cancer neoadjuvant chemotherapy in the near future curative effect evaluationObjective:To evaluate the effectiveness of different approaches to advanced gastric cancer neoadjuvant chemotherapy and security.Methods:A retrospective analysis in January 2012 to January 2014 in the 186 cases of patients with advanced gastric cancer, with 96 cases who accepted interventional chemotherapy and intravenous chemotherapy in 90 cases, compared two groups of histopathologic response, surgical resection, postoperative complications and adverse reactions such as indicators of differences.Results: ①after neoadjuvant therapy intervention histopathological tumor regression rate is higher than vein group (chi-square=9.211, P 9.211).Interventional chemotherapy group resection rate and radical resection rate were higher than intravenous chemotherapy group, the radical resection rate is statistically significant (P= 0.043).Adverse reactions between the two groups in addition to the incidence of nausea and vomiting, abdominal pain and evil cold fever outside intervention group is higher than the vein group (chi-square=5.401, P=0.003; chi-square=8.816, P=0.032; chi-square=9.450, P= 0.009), no obvious difference was found between the rest;The postoperative complications in the two groups had no significant difference (P>0.05).②3 cases of patients with pathologic complete response, follow-up found that 1 case death,2 cases of recurrence survived to the present.Conclusions:Neoadjuvant interventional chemotherapy compared with intravenous chemothera-py in the tumor response rate, histopathologic response and improve the radical resection has the advantage, no obvious adverse reaction and severe surgical complications.Part Ⅲ Spleen and nourishing the stomach the prevention and treatment of advanced gastric cancer postoperative adverse reaction of chemotherapy efficacy researchObjective:Explore the spleen and nourishing the stomach party the curative effect of nausea and vomiting prevention and treatment of postoperative chemotherapy for gastric carcinoma.Methods:Retrospective analysis in January 2012 to January 2012 in 176 cases of patients with postoperative chemotherapy for gastric carcinoma, with 92 cases in patients with Chinese medicine decoction oral as treatment group, did not receive 84 patients with oral medicine as control group, end of the observation process begin chemotherapy and chemotherapy. Statistics of two groups of cases at all levels of the incidence of nausea and vomiting.Results: ①After oral medicine intervention in the treatment group used anti-nausea drug dosage intervention group was obviously lower vein group, the difference statistically significant (P< 0.01). ②Level between the two groups was no difference in the incidence of nausea and vomiting, but the treatment group level 2 and level 3 the incidence of nausea and vomiting significantly lower than the control group (χ2=4.251, P=0.048), (χ2=4.869, P=0.035).Conclusion spleen and nourishing the stomach can be very good to prevent postoperative chemotherapy in advanced gastric cancer incidence of nausea and vomiting, significantly reduce the incidence of grade 2 and 3 levels of nausea and vomiting.③ The spleen and nourishing the stomach Fang Gan prognosis, and postoperative chemotherapy for six course completion treatment group was obviously higher than that of control group (χ2=0.858, P=0.858).Conclusions:①Spleen and nourishing the stomach can be very good to prevent postoperative chemotherapy in advanced gastric cancer incidence of nausea and vomiting, significantly reduce the incidence of grade 2 and 3 levels of nausea and vomiting. ②Spleen and nourishing the stomach can effectively improve the postoperative chemotherapy completion. |
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