Study On The Distribution And Variation Of TCM Syndromes Before And After ESD In Patients With Early Gastric Cancer And Precancerous Lesions

Purpose:This paper mainly studies the distribution and changes of TCM syndrome types before and after ESD in patients with early gastric cancer and precancerous lesions,which belongs to a more forward-looking research method.Among them,the influence of ESD minimally invasive surgery is discussed in the treatment of TCM syndrome types,and the follow-up treatment and prevention of this disease can be treated according to syndrome differentiation in stages,which can serve better in clinical aspects after reference.Methods:From December 2019 to December 2020,a prospective study was conducted on 131 inpatients in the digestive endoscopy center ward of Jiangsu Provincial Hospital of Traditional Chinese Medicine.The patients in this study are mainly those who actively request ESD treatment and whose postoperative pathology accords with the category of early gastric cancer and precancerous lesions.Among them,the general data,endoscopic data and pathological data of patients will be recorded in detail,and the TCM Syndrome Information Questionnaire will be made uniformly.By collecting patients at four time nodes,namely,before admission,2 weeks after operation,1 month after operation and 3 months after operation,and through careful observation and inquiry recorded in the Questionnaire of TCM Syndrome Types Information,as well as the collected information of four diagnoses,the syndrome types in each stage were evaluated respectively,and the evaluation standard was Diagnostic Criteria for Common Syndrome of TCM.Among them,the general data,endoscopic data and pathological data of patients are analyzed by statistical software,and whether the preoperative syndrome types will be affected will be analyzed in detail through various data.In addition,we will further discuss the TCM syndrome types before and after ESD,and finally understand its evolution law.Results:①131 cases of early gastric cancer and precancerous lesions were taken as the study cases:1.The ratio of male to female was 2.20:1,and the ratio of male to female was 68.7:31.3.Among them,there were 90 males and 41 females.There are more men than women.In these cases,27 people aged 40-60 years old,86 people aged over 60 years old,the number increased after 60 years old,and only 3 people were under 40 years old,indicating that the number of patients with early gastric cancer and precancerous lesions began to increase after 40 years old.2.Among these 99 cases,the most common lesions were in the middle third and the lower third of the stomach,among which 70 cases were concave,accounting for 75.6%of the total patients.Among them,94 cases(71.8%)had lesions ranging from 0.5～2.0cm to 2.0 cm.In 131 cases of surface erosion,the proportion of patients with lesion characteristics accounted for 92.4;46 nodules accounted for 35.1%;13 ulcer patients accounted for 9.9%;Among them,the positive rate was 16.0%,which was 21 patients with Hp infection.3.Adenocarcinoma,LGIN and HGIN account for 31.3%,35.1%and 31.3%of the pathological types respectively,among which these proportions are relatively close.121 cases of lesions originated from mucous membrane,belonging to the research cases of infiltration depth,accounting for 92.4%.Secondly,10 cases(7.6%)belonged to submucosa.Among the 44 patients,54.5%were differentiated,18.2%were low,and 27.3%were highly differentiated.②Among the 131 patients with early gastric cancer and precancerous lesions studied,patients with age,sex,lesion location,lesion range,pathological type,infiltration depth and differentiation degree have no influence on the distribution of syndrome types in the above aspects(P>0.05);The distribution of symptomatic types has influence on the lesion shape,lesion characteristics(surface erosion,ulcer,nodule)and Hp infection(P<0.05).③131 patients with early gastric cancer and precancerous lesions were studied,including spleen-stomach weakness=spleen-stomach deficiency and cold=stomach yin deficiency<spleen-stomach weakness<stomach collaterals stasis<spleen-stomach damp-heat<liver-stomach disharmony.These are TCM syndrome types(cases)before operation.Stomach yin deficiency syndrome<spleen and stomach deficiency and cold syndrome<spleen and stomach weakness syndrome<stomach collaterals stasis syndrome<liver and stomach disharmony syndrome<spleen and stomach damp-heat syndrome.This is a TCM syndrome type(number of cases)2 weeks after operation.Liver-stomach disharmony syndrome<spleen-stomach damp-heat syndrome<spleen-stomach deficiency cold syndrome<stomach collaterals stasis syndrome<stomach yin deficiency syndrome<spleen-stomach weakness syndrome,all of which are TCM syndrome types(cases)one month after operation.Spleen-stomach damp-heat syndrome<stomach collaterals stasis syndrome=disharmony between liver and stomach<spleen-stomach deficiency cold syndrome<spleen-stomach weakness syndrome<stomach yin deficiency syndrome.These are TCM syndrome types(cases)3 months after operation.Conclusions:①Generally,after 40 years old,there are more patients with early gastric cancer and precancerous lesions,and the proportion of males is higher,and the increase of patients at 60 years old is more obvious.Among them,Hp positive infection rate is not high,and the common shape is concave,mostly concentrated in the middle and lower third of the stomach,and the size is between 0.5～2.0 cm.Nodular hyperplasia on the mucosal surface of the lesion is less,and the mucosal surface is almost erosive and congested,and surface ulcer is relatively rare.Adenocarcinoma,LGIN and HGIN are the most common pathological types in patients with early gastric cancer and precancerous lesions.Mucosal lining is the origin of lesions,and the degree of differentiation is mostly in the middle.②The disharmony between liver and stomach and damp-heat syndrome of spleen and stomach are the focus types of depression and surface erosion,while the depression type and surface erosion of stomach collaterals stasis syndrome are less.Most of the spleen and stomach damp-heat syndrome is Hp infection and superficial ulcer.It is a common focus syndrome type with superficial nodular hyperplasia,which is mainly caused by stagnation of stomach collaterals.The focus type of superficial nodular hyperplasia of spleen-stomach damp-heat syndrome is relatively rare.③The patients with early gastric cancer and precancerous lesions showed a general change from excess syndrome to deficiency syndrome,among which the distribution of TCM syndrome types before and after ESD was regular.The syndrome of stagnation of stomach collaterals is less than the syndrome of disharmony between liver and stomach and the syndrome of damp-heat in spleen and stomach.Stomach yin deficiency syndrome and spleen and stomach weakness syndrome are mostly postoperative deficiency syndrome,while spleen and stomach deficiency and cold syndrome are less postoperative deficiency syndrome.