1. Changes in the postoperative physiological structure of patients with esophageal and cardia cancer are the key to cause postoperative discomfort in patients.
The reasons may be as follows [3]: ① The proximal gastric resection destroys the stomach’s ability to admit and store food, and also removes the gastric electrical pacing point, thus affecting the distal gastric movement. ②Severance of the vagus nerve trunk and branches during surgery for esophageal and cardia cancers is the main cause. The severing of the upper vagus nerve branch restricts the expansion of the stomach and reduces the ability of the stomach to accommodate food. ③ Intraoperative gastric prolonged exposure and light irradiation, temperature changes, and intraoperative stretching of the gastric wall caused different degrees of damage to the gastric wall tissues, and the reduction of blood supply to the remnant stomach after gastric freeing, and poor blood supply in the short term, which affected the tension of the gastric wall. After one year, the secretion of gastrin from the thoracic stomach was basically restored. Gastrin has the function of increasing the frequency and sensitivity of the pacing point, promoting the secretion of gastric juice, contraction of gastric sinus and the growth of digestive tract mucosa. Therefore, the decrease of gastrin in the early postoperative period is one of the causes of thoracic gastric emptying disorder.
2. Postoperative patient management and pharmacological interventions are very important to improve the quality of life of patients.
Patients with esophageal and cardia cancer should not be simply treated as “one and done”, and it is especially important to guide patients and provide appropriate drug interventions after surgery. ① Relieve patients’ nervousness, build up confidence, “the operation is successful, the possibility of recurrence is very small”, and cheer patients up; ② Eat reasonably, less and more meals, and supplement sufficient calories, vitamins, trace elements and proteins; avoid too greasy and spicy stimulating foods. ③According to the situation, reasonable drug treatment, such as the performance of fullness, do not want to eat, can be given to the gastric power drugs, such as dopamine receptor blocker gastrin, morpholine; 5-hydroxytryptamine receptor antagonist class, such as Mosapride. Proton pump inhibitors, such as omeprazole, may be given if heartburn, panacidity, and chest pain are manifested. If the symptoms are mild, can also be given with ranitidine, magnesium aluminum carbonate tablets, etc.
3, postoperative to deficiency, postoperative stay evil is the main pathological basis.
Ancestral medicine believes that the spleen and stomach is the origin of the latter, the source of Qi and blood biochemistry, such as “Suwen? For example, “Yuji Zhenzang” says: “The five organs are all endowed with qi in the stomach; the stomach is the source of the five organs”. The Jing Yue Quan Shu says: “The earth is the source of all things, the stomach is the master of nourishment, the stomach is strong, the stomach is weak, the stomach is weak”. Esophageal and pancreatic cancer surgery most often leads to positive deficiency, which is mainly manifested in two aspects: deficiency of stomach qi and loss of yin and blood. Insufficient gastric qi will affect the organizing and ripening function of stomach, which will lead to lack of source of qi and blood biochemically, and further cause deficiency of spleen and stomach qi and loss of transportation and transformation keys. The loss of fluid and blood during surgery also leads to loss of gastric moistening, loss of gastric harmony and lowering, which further affects the function of the stomach. Intraoperative depletion combined with postoperative biochemical deficiency eventually leads to deficiency of qi and blood. In severe cases, it even causes deficiency of multiple organs such as heart, lung, liver and kidney. The postoperative retention of evil is mainly manifested in several aspects, one is the residual poison internal knot, that is, the surgery fails to completely remove the poisonous evil in the body. Secondly, due to the postoperative weakness of the spleen and stomach, the loss of key of transportation and transformation, water and dampness stagnate inside, and dampness stagnates as phlegm, which leads to phlegm and dampness blockage. Thirdly, intraoperative damage to the stomach ligaments and internal stagnation of silt and blood. For example, in “Ling Shu? All Diseases Begin to Grow”, it is said that “Yang luo injury will lead to blood overflow …… Yin luo injury will lead to blood overflow”. Injury to the stomach ligaments after esophageal and cardia cancer surgery often leads to internal stagnation of blood. As mentioned above, the pathological mechanism of postoperative esophageal and cardia cancer patients is more complicated, and they often suffer from deficiency of both qi and blood, heat and toxicity, phlegm and dampness, and stagnation of blood.
4. Chinese medicine evidence is mainly mixed with deficiency and reality.
Postoperative cases of esophageal and cardia cancer patients show a mixture of deficiency and reality. Among them, spleen and stomach qi deficiency with phlegm and dampness congestion is the most common. In addition, from the gastroscopic manifestations, a large proportion of patients have mucosal congestion and edema, anastomotic erosion and ulceration, which should belong to the category of “gastric heat” according to the microscopic evidence of gastroscopy]. The treatment is often more effective than that of the other two. Not only can achieve the purpose of anti-inflammatory and swelling, but also can release the remaining toxins to prevent recurrence. Then use some Chinese medicine with the role of acid-protective film, such as white and, zhebei mother, cuttlebone, lotus root powder, etc. is more conducive to the healing of erosion, ulcers, the effect is more significant. Therefore, how to pay attention to the identification of evidence combined with the identification of disease, traditional Chinese medicine identification combined with modern microscopic dialectic, to better explore and solve the problems of postoperative patients deserve further study.