| Part 1ObjectiveTo evaluate the effect of using ultrasonic scalpel to open the thoracic aorta vagina vasorum of rabbit.Methods54 New Zealand rabbits whose proportion of male and female was 1:1 and weighing 2.5～3. Okg, were divided randomly into MAX group, MIN group and control group. There were 18 rabbits in each group. The experimental animals were fixed in the supine position after anesthetized by 3% sodium pentobarbital (40mg/kg) intravenously. The target vessel thoracic aorta was found after the thoracic cavity and abdominal cavity were opened along the medioventral line longitudinally. The thoracic aorta vagina vasorum was opened along the ordientation of the aorta by a scissor in control group. Length is about 5 cm. While the "MAX" key of ultrasonic scalpel in the MAX group and the "MIN" key of ultrasonic scalpel in the MIN group accordingly. The time to use the ultrasonic scalpel was 3 seconds a time. The strength and amplitude were kept consistent as far as possible. The vascular tissue of the operation part was taken after the thoracic aorta vagina vasorum opened. After 2 hours Formalin-fixed. Paraffin-embedded tissue sections were dewaxed in xylene, rehydrated with alcohol. Hematoxylin stained the cell nuclei for 5 minutes and eosin stained the cell plasma for seconds to several minutes. The stained tissues were observed and photographed by optical microscope. The organization morphological changes were observed from middle and outer membrane of the blood vessel wall. The data was recorded.ResultMassive hemorrhage and damage of surrounding viscera did not happen before the target vessels were taken during the experiment process. There were no organization morphological changes(damage of the outer membrane of blood vessel and structure disorder) in the control group and the MAX group, while there was one in the MIN group.ConclusionIt is safe to use a ultrasonic scalpel to open the rabbit vagina vasorum. The blood vessel could be damaged to a certain degree when using the "MAX" key of the ultrasonic scalpel to operate between the vagina vasorum and the tunica adventitia. The result might be related with the thermal damage of ultrasonic scalpel. The conclusion is limited to the thoracic aorta vascular of rabbit. organization morphological changes(damage of the outer membrane of blood vessel and structure disorder) in the control group and the MAX group, while there was one in the MIN group.Part 2ObjectiveTo evaluate and compare the curative effect and safety of vagina vasorum lymph node dissection(VLND) and non-vagina vasorum lymph node dissection (NVLND) in patients with advanced gastric cancer in D2 gastrectomy.Methods47 cases of evaluable patients with advanced gastric cancer, underwent radical gastrectomy from June 2013 to October 2014 were retrospectively analyzed in general surgery of General Hospital of Guangzhou Military Command. Of which,23 cases patients received VLND. And 24 cases patients received NVLND. Two groups of the patients who underwent radical gastrectomy were by the same physician team. According to the 2011 version of the gastric cancer diagnosis and treatment guidelines, D2 radical gastrectomy is the standard operation for advanced gastric cancer patient. The patients whose tumor infiltration depth is under the submucosa(submucosa or advanced), or with the lymph node metastasis but not invading the adjacent viscera, shall be received standard D2 radical gastrectomy. According to the guidelines, the primary lesions should be removed completely, with the regional lymph nodes cleaned thoroughly. with regard to the localized growth gastric cancer, the surgical margins should be at least 3 cm, while the surgical margins should be at least 5 cm when it is infiltrative. The patients in Group B received vagina vasorum lymph node dissection in coeliac trunk, hepatic artery and splenic artery on the basis of standard D2 gastrectomy. The interfacial debonding is between vagina vasorum and the thin layer gap of outer membrane. The ultrasound scalpel is used to remove the vagina vasorum, the nerve fibers and lymphatic connective tissues outside, to make it "skeletonized". Oxaliplatin combined with S-1 as systemic vein chemotherapy is used in the postoperative patients above. They were followed at the same time. The follow would not be ended until they are dead. The last follow-up time is February 1,2015. Overall survival (OS) was calculated to perform statistical analysis.ResultThe operations were completed successfully, without massive hemorrhage, injury of adjacent viscera and important vascular and the other accidents. There were no perioperative death among the two groups. No significant differences in blood loss(324.58±27.54ml VS 320.21±14.02ml) (P>0.05). The average amount of lymph nodes in VLND group was 25.42, which was higher than the amount in control group(18.91, P<0.05). There were 4 complications among NVLND group(4/23,17.4%),2 cases delayed gastric emptying,1 case intestinal obstruction and 1 case surgical incision infection included. With no significant differences, there were 4 complications among NVLND group(4/24, 16.67%, P<0.05),1 case delayed gastric emptying,1 case intestinal obstruction and 1 case surgical incision infection included.In this study.The average duration of follow-up was 15 months while the longest follow-up time was 23 months and the shortest is five months. At 3-month follow-up, there were no disease progresses in both groups. At 6-month follow-up, there were two patients with disease progress in NVLND group and one in VLND group. At 12-month follow-up, there were nine patients with disease progress in NVLND group and seven in VLND group.ConclusionFor advanced gastric cancer patients, surgery is still the main treatment. Under certain conditions, standard D2 radical gastrectomy combining with vagina vasorum lymph node dissection in coeliac trunk, hepatic artery and splenic artery is safe, without increasing the incidence of intraoperative massive haemorrhage and postoperative complications. It can improve the completeness of lymph node cleaning, at the same time not increasing the risk of surgery on the premise that the leading physicians should be familiar with the anatomy knowledge and own the ability to a certain experience in D2 radical gastrectomy. Vagina vasorum lymph node dissection satisfies the principal of modern oncology and operative surgery of RO radical gastrectomy, which is recommended when clearing lymph node around arteries in radical gastrectomy for advanced gastric cancer patients above. In a word, VLND is a safe technique with high radical resection rate and the post-operation survival rate. |
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