RESUMO
PURPOSE: Ultrasonic harmonic scalpel has been widely applied to laparoscopic surgery of gastric cancer, but it has not been evaluated properly in open surgery. The objective of this study was to evaluate the value of the ultrasonic harmonic scalpel in the open radical surgery of gastric cancer. METHODS: 106 gastric cancer patients who had accepted distal D2 lymphadenectomy were included in this study. Patients were divided into ultrasonic harmonic scalpel (UHS) surgery group (50 cases) and conventional electric scalpel surgery group (56 cases). UHS surgery group patients were accepted surgery by ultrasonic harmonic scalpel. Instead, conventional electric scalpel surgery group patients were accepted surgery by monopolar electrocautery shovel and other traditional instruments. Then the average operation time, intra-operative blood loss, number of harvested lymph nodes, average post operative drainage within 3 days, and postoperative hospital stay were collected and compared between the two groups. RESULTS: The average operation time, blood loss, postoperative hospital stay in UHS group were significantly lower than traditional group (P < 0.05). The number of lymph node dissection was significantly higher than conventional surgery group (P < 0.05). There were no difference between two groups in average drainage within 3 days after surgery and the hospitalization costs (P > 0.05). In the presence of atherosclerotic patients, the average operation time, blood loss in UHS surgery group were significantly lower than the traditional group (P < 0.05). CONCLUSION: Ultrasonic harmonic scalpel may have better effect in the radical surgery of gastric cancer patients. It meets the requirements of the future development of precise surgical procedure.
Assuntos
Excisão de Linfonodo/instrumentação , Neoplasias Gástricas/cirurgia , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , PrognósticoRESUMO
OBJECTIVE: The objective of this study is to acquire CT images of the celiac artery by 64-multi-slice spiral CT angiography (64-MSCTA) in gastric cancer patients to facilitate gastric cancer surgery. METHODS: Preoperative 64-MSCTA was performed to observe the origin, course and anatomical variations of the celiac artery and vascular calcifications in 102 gastric cancer patients. RESULTS: (1) The celiac trunk mostly arose at the level between the 12th thoracic vertebra and the 1st lumbar vertebra; the mean inferior angle with the abdominal aorta was 63.5° (14°-159°), the mean length was 36.29 mm (5.80-73.58 mm), and its course showed many styles. (2) Of 102 gastric cancer patients, 34 patients (33.33 %) were observed with celiac artery variations of whom there were 27 patients with anatomical variations of the hepatic artery, 3 patients with anatomical variation of the left gastric artery and 1 patient with anatomical variation of the splenic artery; in 1 patient, the celiac trunk and the superior mesenteric artery originated from a common trunk. In other cases, it was observed with another variation. (3) The abdominal aortic calcified plaque was observed in 48 patients (47.1 %), and among them, 34 patients were more than 60 years old, and the existence of the abdominal aortic calcified plaque was related to age, significantly (P < 0.01). CONCLUSIONS: The 64-MSCTA largely improves our understanding of the origin, course and anatomical variations of the celiac artery and vascular calcifications in individual patient with gastric cancer. It is recommended that the 64-MSCTA of the celiac artery should be classified as a routine preoperative procedure in gastric cancer patients.
Assuntos
Calcinose/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Estômago/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Biomédica , Calcinose/cirurgia , Artéria Celíaca/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Prognóstico , Estômago/cirurgia , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND: Surgical resection remains the principal treatment for advanced gastric cancer. However, one of the difficulties in radical D2 lymphadenectomy is the identification of the vascular abnormalities around the stomach, especially abnormal hepatic artery. The hepatic artery arising from the superior mesenteric artery shows great variations, and whether or not the lymphatic tissues around the abnormal artery should be dissected is still controversial. METHOD: Eighty-six gastric cancer patients who underwent radical D2 lymphadenectomy by the same surgeon in our department in the past 2 years were included in this study. All patients underwent multislice spiral computed tomography angiography for preoperative evaluation of the abnormal hepatic artery arising from the superior mesenteric artery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed using CK20 and CEA antibodies to determine the occurrence of lymph node micrometastasis around the abnormal artery. RESULTS: In our study, we found 14 cases with an abnormal hepatic artery arising from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. Immunohistochemical analyses revealed no micrometastasis in the lymphoid tissues surrounding the abnormal artery. CONCLUSIONS: Abnormal hepatic arteries arising from the superior mesenteric artery can be classified into pre-pancreas and post-pancreas types. Lymph nodes around the abnormal artery may not need to be dissected in radical D2 lymphadenectomy.