云母对早期胃癌内镜黏膜下剥离术术后人工溃疡愈合的有效性研究OA

Objective To evaluate the clinical efficacy of mica in treating artificial ulcer after endoscopic submucosal dissection(ESD)for early gastric cancer.Methods A total of 114 patients with early gastric cancer who received ESD treatment in the Second Affiliated Hospital of Zhejiang Chinese Medical University from July 2022 to January 2024,were selected and randomly divided into three groups using the random number table method:the proton pump inhibitor(PPI)group(n=38),the PPI+sucralfate group(n=37),and the PPI+mica group(n=39).Ten patients dropped out,and ultimately 104 patients completed the trial(34,35,and 35 in the PPI,PPI+sucralfate,and PPI+mica groups,respectively).On the first day after ESD,all patients in the three groups began fasting and gastrointestinal decompression,and received intravenous infusion of pantoprazole sodium,40 mg each time,twice a day for 3 days.From the fourth day after the operation,they started on a liquid diet and received the corresponding drug for 2 months.Patients in the PPI group only received pantoprazole sodium enteric-coated capsules,40 mg each time,once a day.Based on taking pantoprazole sodium enteric-coated capsules,patients in the PPI+sucralfate and PPI+mica groups received sucralfate suspension gel(1 g each time,twice a day)and mica suspension(3 g each time,twice a day),respectively.On the first and 90th days after ESD,the serum contents of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),prostaglandin E2(PGE2),epidermal growth factor(EGF),and vascular endothelial growth factor(VEGF)were detected using an enzyme-linked immunosorbent assay(ELISA).Gastroscopy was performed on the 90th day after ESD to observe the size and stage of the artificial ulcer and calculate the artificial ulcer reduction rate.Gastric mucosal tissue samples were taken from the edge area of the artificial ulcer,and Masson staining was used to detect the ratio of collagen fiber deposition area in the gastric mucosa.Immunofluorescence staining was used to detect the positive expressions of type Ⅰ and type Ⅲ collagen in the gastric mucosa,and ELISA was used to detect the hydroxyproline(HYP)content in the gastric mucosa.Results Compared with the PPI group,the artificial ulcer reduction rate was increased,and the ulcer stage was improved in the PPI+sucralfate and PPI+mica groups(P<0.05);the serum contents of PGE2,EGF,and VEGF were elevated(P<0.05);the morphology of gastric mucosa was changed,a large amount of collagen fibers were deposited,and the ratio of collagen fiber deposition area was increased(P<0.05);and the positive expression of type Ⅰcollagen,the value of type Ⅰ/type Ⅲ collagen,and the HYP content in gastric mucosa were all elevated(P<0.05).Compared with the PPI+sucralfate group,the artificial ulcer reduction rate and the value of type Ⅰ/type Ⅲ collagen in gastric mucosa were increased in the PPI+mica group(P<0.05).Conclusion PPI combined with mica can accelerate the healing of artificial ulcers after ESD for early gastric cancer,promote the histological maturation of regenerated mucosa,and improve the quality of artificial ulcer healing.