Objective To establish rabbit VX-2 carcinoma with pyloric obstruction model and evaluation of 5-Fluorouracil、docetaxel and oxaliplatin neoadjuvant chemotherapy combined with enteral parenteral nutrition on gastric cancer with the therapeutic effect and safety for the pyloric obstruction in a rabbit model.Methods 42 rabbits were randomly divided into the control group and the treatment group by injecting VX-2 tumor cell suspension to establish a rabbit model of gastric cancer with obstruction.All rabbit models treatment blood routine,liver and kidney function,electrolytes detection forward,the control group rabbits were 21,give direct resection of gastric cancer or gastrojejunostomy;treatment group rabbits were 21,given preoperative neoadjuvant chemotherapy combined with enteral and parenteral nutrition after reoperation.Records of chemotherapy combined with enteral and parenteral nutrition in the treatment of rabbit model of survival,all the rabbits died the day be abdominal and thoracic,determine the primary tumor size in the gastric antrum,pyloric obstruction degree and Metastases situation,respectively in treatment before laparotomy,died that day to take primary lesions or metastasis lesions were,he staining,under optical microscope observed.After the death of rabbits,gastric cancer was taken in situ or metastatic tumor.The expression levels of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemistry.Results (1) Experimental group and control group of gastric cancer radical resection rate was 85.5％ (18/21) and 66.7％ (14/21),the experimental group was significantly higher than the control group,the difference was statistically significant (P ＜ 0.05).(2) In the experimental group and control group,the amount of bleeding,operation time,and postoperative anastomotic leakage or duodenal fistula,bleeding,stress ulcer bleeding and intestinal obstruction were not statistically significant (P ＞ 0.05).In the treatment group,the incidence of postoperative abdominal infection,pulmonary infection and gastric paralysis was significantly lower than that of the control group (P ＜ 0.05).(3) Compared with the control group,the degree of metastasis of abdominal cavity in the experimental group was less than that in the control group,and there was less liver metastasis and less metastatic nodules.(4) Control group ePCI score was 18.00 ± 1.55,the experimental group ePCI score was 12.00 ± 1.79,the difference between the two groups was statistically significant (P ＜0.01).The abdominal adhesion score of control group was 3.67 ± 0.52,the abdominal adhesion score of the experimental group was 1.17 ±0.75,and there was a significant difference between the two groups (P ＜ 0.01).(5)The gray value of VEGF expression in the control group was 77.33 ± 6.77,the gray value of the experimental group VEGF was 200.17 ±4.26,the gray value of the control group PCNA was 83.33 ±3.49,the gray value of the experimental group PCNA was 184.83 ± 3.76.The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion Preoperative neoadjuvant docetaxel and oxaliplatin combined with enteral and parenteral nutrition support treatment to control the progression of gastric carcinoma and relieve pyloric obstruction has a better effect and higher safety.%目的 建立兔VX-2胃癌伴幽门梗阻模型,探讨氟尿嘧啶、多西他赛和奥沙利铂新辅助化疗联合肠内肠外营养对胃癌伴幽门梗阻的兔模型的治疗效果及安全性.方法 通过注射VX-2肿瘤细胞悬液建立兔胃癌伴幽门梗阻模型,将42只兔模型随机分为对照组和治疗组.所有兔模型治疗前行血常规、肝肾功能、电解质检测,对照组大白兔21只,给予直接胃癌切除手术或胃空肠吻合术;治疗组大白兔21只,给予术前新辅助化疗联合肠内肠外营养后再行手术.记录化疗联合肠内肠外营养治疗后兔模型生存情况,所有兔死亡当天予以剖腹及开胸,观察尚存胃窦部原发癌灶大小、幽门梗阻程度、转移癌灶等,分别于治疗前开腹探查时、死亡当天取原发病灶或转移病灶标本,苏木素-伊红(HE)染色,在光学显微镜下观察.兔死亡后取胃原位癌灶或转移癌灶,免疫组织化学检测血管内皮生长因子(VEGF)和增殖细胞核抗原(PCNA)表达浓度.结果 (1)实验组和对照组胃癌根治性切除率分别为85.5％(18/21)和66.7％(14/21),实验组显著高于对照组,差异有统计学意义(P＜0.05).(2)实验组与对照组在术中出血量、手术时间,及术后发生吻合口瘘或十二指肠瘘、大出血、应激性溃疡出血和肠梗阻差异无统计学意义(P＞0.05).而实验组在术后发生腹腔感染、肺部感染及胃瘫较对照组明显降低(P＜0.05).(3)对照组死亡标本解剖见典型胃癌转移瘤特征,与对照组比较,实验组腹腔转移程度较轻,出现肝转移较少,转移结节较小.(4)对照组实验性腹膜转移癌指数(ePCI)评分为(18.00±1.55)分,实验组ePCI评分为(12.00±1.79)分,两组差异有统计学意义(P＜0.01).对照组腹腔内粘连评分为(3.67 ±0.52)分,实验组腹腔内粘连评分为(1.17 ±0.75)分,两组间腹腔内粘连评分评分比较差异有统计学意义(P＜0.01).(5)对照组VEGF表达的灰度值为77.33±6.77,实验组VEGF表达的厌度值为200.17 ±4.26,对照组PCNA表达的灰度值为83.33±3.49,实验组PCNA表达的灰度值为184.83 ±3.76.两组比较差异均有统计学意义(P＜0.05).结论 氟尿嘧啶、多西他赛和奥沙利铂术前新辅助化疗联合肠内肠外营养支持治疗对控制胃癌进展和缓解幽门梗阻有较好效果,且安全性较高.
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