| Purpose:To observe the effect of bletilla striata polysaccharide on the healing of artificial ulcer after gastric ESD surgery,and to explore the effect of bletilla striata polysaccharide on artificial ulcer from the theory of "stomach selection",and to provide a new idea for the treatment of artificial ulcer by combining traditional Chinese and western medicine.Materials and METHODS: A total of 60 patients who underwent gastric endoscopic mucosal dissection during their hospitalization in the Diagnosis and Treatment Center for Digestive Minimally Invasive Diseases of The Northern Theater Command General Hospital from September 2020 to December 2021 were strictly selected according to the criteria,and were randomly divided into control group(n =30)and experimental group(n = 30).On the fourth day after surgery,the control group was given oral esomeprazole magnesium enteric-coated tablet 40 mg 1/ day;In the experimental group,esomeprazole magnesium enteric-coated tablet was orally added with bletilla polysaccharide capsule 1 tablet/time,2 tablets/day;The treatment course of both groups was 4 weeks.After 4 weeks of treatment,artificial ulcer healing,area size,ulcer inhibition rate,TCM clinical symptom score,incidence of ulcer basal protrusion and ulcer healing score,medication safety evaluation(ALT and AST,CR and BUN),and postoperative pathological diagnosis were observed and compared between 2 groups.Results:1.After 4 weeks of treatment after ESD,patients in the experimental group were significantly better than those in the control group.The ulcer area of the 60 patients was smaller than the initial ulcer area,and the surrounding mucosa regeneration and healing were obvious,but some patients still had mild hyperemia,edema,covered with a small amount of white moss and other active manifestations of the surrounding mucosa.Among the 30 patients in the experimental group,ulcer healing was in active stage(A1 and A2)in 5 cases(16.67%),healing stage(H1 and H2 stage)in 20 cases(66.66%),scar stage(S1 and S2 stage)in 5 cases(16.67%).Overall significant efficiency 25 cases /30 cases(83.33%);Among the 30 patients in control group,ulcer healing was in active stage(A1 and A2)14 cases(46.67%),healing stage(H1 and H2stage)15 cases(50.00%),scar stage(S1 and S2 stage)1 case(3.33%).The overall significant efficiency was 16 cases /30 cases(53.33 %).2.Ulcer area and ulcer inhibition rate of patients after 4 weeks of treatment after ESD were compared,the ulcer area of experimental group(0.83±0.07)and control group(1.57±0.57)were significantly different(P < 0.01).The ulcer inhibition rate of experimental group(0.88±0.10)and control group(0.83±0.54)was significantly different(P < 0.01).3.After 4 weeks of treatment after ESD,the incidence of basal protrusion observed by gastroscopy and the number of cases evaluated by ulcer healing were compared,and the experimental group was significantly better than the control group.In experimental group,5 cases(16.67%)had protuberance near ulcer base,20 cases(66.67%)had no protuberance near ulcer base,but not plain white ulcer scar,5 cases(16.66%)had no protuberance near ulcer base,and completely covered by regenerated epithelium.The total number of ulcer without obvious protrusion was25/30(83.33 %).In the control group,14 cases(46.67%)had protuberance near the ulcer base,15 cases(50.00 %)had no protuberance near the ulcer base,but not plain white ulcer scar,1 case(3.33 %)had no protuberance near the ulcer base,and the plain white ulcer scar was completely covered by regenerated epithelium.There were16 cases(53.33 %)without obvious protuberance.4.After 4 weeks of treatment after ESD,the incidence of ulcer basal protrusion was observed by gastroscopy and ulcer healing score was compared by Mann-Whitney U test: Z=-2.740,P=0.006.Combined with the experimental data,it was concluded that the incidence of basal ulceration in the experimental group was lower than that in the control group,and the difference was statistically significant(P < 0.01).5.Comparison of efficacy scores of single TCM syndromes after 4 weeks of treatment after ESD surgery The experimental group had stomach distension pain(0.93±0.41)and the control group had stomach distension pain(2.13±0.50),the experimental group had depression or irritability(0.27±0.09)and the control group had depression or irritability(0.93±0.25),the experimental group had chest and hypochondriac distension pain(0.53±0.09)and the control group had chest and hypochondriac distension pain(0.80±0).09),the experimental group belched or sighed(0.60±0.09)and the control group belched or sighed(0.67±0.06),and the difference in appetite between the experimental group(0.73±0.08)and the control group(1.87±0.61)was statistically significant(P < 0.01).6.The total score of TCM syndrome efficacy after 4 weeks of treatment after ESD was compared between the control group(7.27±1.78)and the control group(18.67±4.77),the difference was statistically significant(P < 0.05);There was statistically significant difference between the experimental group(3.53±1.46)after 4 weeks of treatment and the experimental group(19.07±4.57)before treatment(P < 0.05);After 4 weeks of treatment,the difference between the experimental group(3.53±1.46)and the control group(7.27±1.78)was statistically significant(P < 0.01).7.After 4 weeks of treatment,the experimental group was better than the control group.In experimental group,0 cases(0.00 %)were invalid,2 cases(6.70%)were effective,28 cases(93.30%)were effective and 0 cases(0.00 %)were cured.In control group,0 cases(0.00 %)were invalid,29 cases(96.70 %)were effective,1case(3.30 %)was effective and 0 cases(0.00 %)were cured.8.Safety evaluation indexes(ALT,AST,Cr and BUN)of patients after ESD treatment were reviewed 4 weeks later,and there was no statistical significance in the experimental group compared with the control group(P > 0.05).9.A complete pathological comparison of patients after ESD showed that in the experimental group,5 cases(16.66%)had low-grade intraepithelial neoplasia,8 cases(26.67%)had high-grade intraepithelial neoplasia,9 cases(30.00%)had carcinoma in situ,8 cases(26.67%)had adenocarcinoma,and the invasion depth was less than500 um.In the control group,there were 3 cases of low grade intraepithelial neoplasia(10.00 %),16 cases of high grade intraepithelial neoplasia(53.34 %),10 cases of carcinoma in situ(30.33 %),1 case of adenocarcinoma and invasion depth ≤500um(3.33 %).After 4 weeks of treatment,the pathological biopsies of both the experimental group and the control group showed chronic inflammation of mucosal tissue.Conclusion:1.The efficacy of bletilla polysaccharide combined with esomeprazole enteric coated tablet in the treatment of artificial ulcer after gastric ESD is superior to esomeprazole enteric coated tablet alone,which can further reduce ulcer area,promote ulcer healing and surrounding mucosal regeneration,improve ulcer inhibition rate and reduce the incidence of ulcer basal protrtion.2.Bletilla polysaccharide joint escitalopram omeprazole enteric-coated metformin hydrochloride treatment stomach ESD postoperative TCM syndrome curative effect is superior to the use of artificial ulcer escitalopram omeprazole enteric-coated metformin hydrochloride,it can significantly improve patients with postoperative clinical symptoms of TCM,in the stomach pain,modern depression or irritability,chest pain,belching,or sigh,inappetence,obvious effects of TCM clinical symptoms.3.Bletilla striata polysaccharide is safe and effective in the treatment of artificial ulcer healing after gastric ESD,and has no side effects. |
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