Objective To investigate the clinical efficacy of complete mesogaster excision in the radical gastrectomy for gastric cancer.Methods The clinical data of 100 patients with distal gastric cancer who were admitted to the First Affiliated Hospital of Harbin Medical University from January 2011 to December 2012 were retrospectively analyzed.All the patients underwent complete mesogaster excision in D2 radical gastrectomy for gastric cancer.The operation quality was evaluated according to operation time,volume of intraoperative blood loss,mean number of lymph nodes dissected,time to flatus,volume of drainage and duration of postoperative hospital stay.Patients were followed up by outpatient examination and telephone interview till May 2014.Results Complete mesogaster excision in the radical gastrectomy for gastric cancer was successfully carried out on all the 100 patients.The operation time,volume of intraoperative blood loss,mean number of lymph nodes dissected,time to flatus,volume of drainage and duration of postoperative hospital stay were (118 ± 34) minutes (range,90-160 minutes),(80±25)mL (range,45-135 mL),38± 10 (range,25-52),(3.0 ± 1.2)days (range,1.5-4.5 days),(62±15)mL (range,15-85 mL) and (7.0±1.5)days (range,4.0-11.5 days),respectively.According to the postoperative pathological results,there were 36 patients with high differentiated gastric carcinoma,38 with moderate and/or low differentiated gastric carcinoma,17 with low differentiated gastric carcinoma and 9 with signet ring cell carcinoma.After operation,3 patients had gastroplegia,2 with poor healing of abdominal incision,2 with duodenal stump fistula,1 with pancreatic fistula,and all of them were cured by conservative treatment.All the 100 patients were followed up for a mean time of 25.6 months (range,17.6-39.2 months).There was no tumor recurrence.Conclusions Complete mesogaster excision in the radical gastrectomy for gastric cancer is safe and feasible,with the advantage of minimal trauma,low morbidity and quick recovery during the follow up.

Objective To probe into the reasons for and results of remedial surgical therapy in thoracic aortic dissection patients after first endovascalar repair.Methods From July 2000 to December 2012,12 cases received second interventional surgery.The average time from second therapy to first surgery was ( 14 ± 11 ) months.Main reasons for second endovascular therapy were sustained type Ⅰ endoleak at proximal landing zone and type A dissection caused by retrograde tear.Therapies included hybrid operations in 8 cases and absnlute endovascular therapy in 4 cases.Results The 30 day mortality after the second intervention was 5.6％ ( 1/12),total mortality rate was 16.7％ (2/12).In 7 cases with endoleak,small endoleak remained after remedial therapy (57.1％ ) in 4 cases.Among 4 cases with secondary type A aortic dissection,successful staged hybrid operation with mid-sternal thoracotomy was adopted in 3 cases,one died of pulmonary emtbolism during follow-up period,1 case with Bebcet disease still had proximal type Ⅰ endoleak after second hybrid operation,and died from tear of aorta.Conclusions Endoleak and secondary type A aortic dissection are the main cause necessitating second intervention after primary endovascular therapy for thoracic aortic dissection.Hybrid operation remains the best choice to treat postoperative complications after endovascular therapy for thoracic aortic dissection.

Objective To compare selective coverage and chimney technology of the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR).Methods Eighty-one cases were retrospectively reviewed from January 2005 to January 2013 with two different management of the LSA during TEVAR:selective coverage (SC) vs chimney (C).Technical success rates,operating time,endoleaks,and perioperative cerebrovascular accidents,spinal cord ischemia (SCI),left arm ischemic symptoms and mortality were analyzed.The survival rate was also evaluated.Statistical analysis was performed using the x2 test,t-test and Kaplan-Meier survival curve.Results There were 37 patients in group SC and 34 in group C.Operating time was (61 ± 22) min for SC,and (101 ± 20) min for C (P =0.000) ; left arm ischemic symptoms occurred in 23.4％ in group SC,and 2.9％ in group C (P =0.011).Technical success rates were 100％ and SCI were 0 for both SC and C.Endoleaks,perioperative cerebrovascular accidents,and mortality were similar between the two groups.Conclusions During TEVAR,selective coverage of the left subclavian artery is safe,effective; meanwhile,chimney technology is safe,effective for patients whose left subclavian arteries need revascularization.

Objective To determine the influence of hostile neck anatomy on type Ⅰ a endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease.Methods From July 2008 to July 2011,195 consecutive patients with non-ruptured abdominal aortic aneurysms (AAA) were treated with EVAR.There were 150 males and 45 females,aging from 52 to 95 years with a mean of 69 years.Forty-three patients were with hostile neck anatomy ( HNA ).High-resolution computed tomography was abtained in all patients,with detailed measurement of proximal neck parameters.Univariate and multivariate analyses were used to compare Ⅰ a endoleak and HNA.Follow-up protocol consisted of computed tomography (CT) angiograms or ultrasound at 3,6,and 12 months,and annually thereafter.Results Twenty-three patients had intraoperative type Ⅰ a endoleaks.The adjunctive measures,such as repeated balloon angioplasty,cuff extension,Palmaz stent placement and chimney technique were used for treating type Ⅰ a endoleak.Small endoleak remained in only one patient.The technical success rate was 98.5％ (192/195).The association between type Ⅰ a endoleak development and magnitude of the infrarenal angle was statistically significant.The mean follow-up time was ( 18 ± 3 )months.The survival rates at 1- and 3-year were 97.4％ and 89.2％ respectively.Conclusions The proximal neck angle is related to intraoperative type Ⅰ a endoleak occurrence,but other factors often thought to be indicative of adverse neck anatomy are not significant predictors.Most type Ⅰ a endoleaks in this study were uccessfully eliminated intraoperatively with a satisfactory mid to long term results.

Objective To evaluate early results of Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).Methods From July 2010 to June 2011,68 patients (57 men,11 women; mean age 74.3 years) were treated with Endurant stent-graft at our center.26 cases had hostile proximal neck in the anatomy.According to ASA classification,15 cases were class Ⅱ ; 32 cases were class Ⅲ and 21 cases were class Ⅳ.Results Intraoperative immediate technical success was achieved in all cases.At completion angiography,a type Ⅱ endoleak was detected in 18 (26％) of the 68 patients.The mean operation time was (96 ± 29) min,the mean blood loss was (99 ± 68 ) ml,and the mean contrast usage was (122 ± 65) ml.No intraoperative conversion to open surgery,stent migration,types Ⅰ/Ⅲ endoleak,other major complications,or death was encountered.49 patients (72％) had a postimplantation syndrome with fever,leukocytosis,and increase of C-reactive protein levels,which completely resolved within two weeks.The mean follow-up time was (8 ± 5) months.Conclusions Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair,even in patients with hostile aortoiliac anatomy.

Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair(TEVAR) in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% (5/27) of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.

Objective To evaluate the safety and efficacy of endovascular repair(EVR)for type B acute aortic dissection(AAD). Methods Between Feb 2002 and May 2008.39 consecutively admitted patients with the confirmed diagnosis of acute type B aortic dissection were studied.All patients were treated bv EVR.Left comnlon carotid artery were covered after bypass in 2 cases.of which fenestrated stent graft (SG)at innominate artery was used in one;1 case underwent left lower extrernity amputation:13 left subclavian artery(LSA)and 1 aberrant risht subclavian artery were completely covered without bypass.5 LSA were pattially covered.All cases were followed by CTA after EVR.the porfusion status of the false lumen were monitored in the aorta at the level of the stented segment(L1)and distal to the stent graft (L2).Results The procedure Was technically successful in all cases;30-day mortality rate was 10.3%.At the 1-month follow-up,false lumen in L1 thrombosed in 100%,a complete thrombosis of the false lumen Was observed in 21 patients(77.8%).partial thrombosis in 6(22.2%).with complete reabsorption of the thrombus and remodelling of the true lumen in 5(18.5%);False lumen in L2 thrombosed only in 7 patients(28%),complete thrombosis in 2(8%)and partial thrombosis in 5(20%).Conclusions The results of endovascular repair of acute type B dissection Was satisfactory.30-day mortalitv rate was related to severe complications before EVR.

Objective:To summarize the midterm to long-term outcomes and experiences of endovascular treatment (ET) of spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 31 SISMAD patients from Jan 2011 to Dec 2019 treated with ET was retrospectively analyzed.Results:Successful ET was achieved in 29 patients with a technical success rate of 93.5%. A total of 36 self-expandable bare stents were planted in 28 patients and plain old balloon angioplastry (POBA) was performed in 1 patient. Abdominal pain disappeared within 24 hours in 89.3% of the patients after stenting. The rate of perioperative complication was 3.2%. There was no SMA dissection rupture bleeding, nor perioperative death occurred. The mean follow-up time was 53.5 (range, 6 to 110) months. There was no dissecting aneurysm formation, no SMA rupture and bleeding, and no stent rupture during the follow-up. The post ET 1-year, 3-year, and 5-year free from reintervention rate were 100%, 100%, and 91.7%, respectively.Conclusions:ET for SISMAD is safe and effective with satisfactory perioperative and midterm to long-term outcomes.

Objective To study the safety and efficacy of detachable fibered coils occlusion system for visceral artery aneurysms.Methods Thirty-three visceral artery aneurysms patients (12 males and 21 females) with an average age of 63.8±3.5 years who underwent endovascular embolization with detachable fibered coils occlusion system combined with standard pushable coils in our hospital were included in this study.Of these patients,20 (60.6％),7 (21.2％),3 (9.1％),2 (6.1 ％),and 1 (3.0％) were respectively diagnosed with splenic artery aneurysm,renal aneurysm,superior mesenteric aneurysm,celiac aneurysm,and pancreaticoduodenal aneurysm.The mean diameter of aneurysms was 16-38 (24.0±3.4)mm.The success rate of detachable fibered coils occlusion system for visceral artery aneurysms,postoperative complications and surgical procedure time were recorded.The patients received CT or ultrasonographic follow up at months 3,6,12 and every year after operation.Results The success rate of detachable fibered coils occlusion system for visceral artery aneurysms was 100％.No intraoperative bleeding and coil migration occurred.One patient with splenic artery dissection did not undergo operation.The patients were followed up for 2-24 (12.5±2.3) months,during which no enlargement or rupture of visceral artery aneurysms and no operation-related severe complication or death occurred.Conclusion Detachable fibered coils occlusion system combined with standard pushable coils is safe and effective for mild and moderate visceral artery aneurysms.

Objective: To systematically evaluate the effect of defunctioning stoma, preoperative radiotherapy, and level of inferior mesenteric artery (IMA) ligation on the postoperative anastomotic leakage in rectal cancer by meta-analysis. Methods: Randomized controlled trials (RCT) published before December 2017 regarding the effects of defunctioning stoma, preoperative radiotherapy, and level of inferior mesenteric artery ligation on the postoperative anastomotic leakage in rectal cancer were searched from PubMed, Embase, Scopus, Cochrane Library, CNKI, Wanfang database, meanwhile open data in unpublished trials from clinicaltrials.gov were retrieved. Associated data were screened according to standard and their quality was evaluated strictly. Review manager 5.3 software was used to perform meta-analysis with data. Random effect model based on DerSimonian and Laird method was applied. Heterogenicity among trials was estimated with Chi-square test. Results: Twenty articles were included in the meta-analysis. The overall incidence of anastomotic leakage was 7.0% (488/7004) . The incidence of anastomotic leakage in the defunctioning stoma group and non-defunctioning stoma group was 5.2% (24/459) and 17.3% (77/445) respectively. The incidence of anastomotic leakage in the radiotherapy group and non-radiotherapy group was 6.5% (188/2900) and 6.1% (179/2946) respectively. The incidences of anastomotic leakage in the low and high IMA ligation groups was 4.7% (6/129) and 11.2% (14/125) respectively. Meta-analysis showed that the incidence in defunctioning stoma group was significantly lower than that in non-defunctioning stoma group (RR: 0.33, 95%CI: 0.21 - 0.50, P < 0.000 01) ; the incidences between radiotherapy group and non-radiotherapy (RR: 1.05, 95%CI: 0.80 - 1.38, P = 0.72) , and between low IMA ligation group and high IMA ligation group (RR: 0.50, 95%CI: 0.20 - 1.23, P = 0.13) were not significantly different. Funnel figure drawn with RCTs about defunctioning stoma and preoperative radiotherapy revealed no significant publication bias existed within included studies. Conclusion Defunctioning stoma can effectively prevent the occurrence of postoperative anastomotic leakage, whereas the preoperative radiotherapy and high IMA ligation may not increase the risk of anastomotic leakage.