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Objective To compare the number of lymph node dissected by intraoperative lymphatic mapping guided D2 gastrectomy and that by standard D2 gastrectomy plus lymphadenectomy in patients of advanced gastric cancer. Methods In this study 20 advanced gastric cancer cases received intraoperative peritumor injection of carbon nanoparticles suspension ( group 1 ) and D2 lymphadenectomy was guided by the black-stained lymph nodes. 21 cases undergoing standard D2 lymphadenectomy served as controls (group 2). The number of lymph nodes removed and the condition of lymphatic metastasis in two groups, blackstained lymph nodes in group 1, and postoperative complications were compared. Results The average lymph nodes dissected in group 1 (35. 1 ± 13.4) were higher than in control group (26.2 ±7.8). The differences were statistically significant (t =2. 126, P =0. 034). The number of removed N2 and N3 lymph nodes in group 1 were more than that in control group. The total black-stained ration of lymph nodes was 52. 7% in group 1. The positive rate of lymph nodes was higher in black-stained lymph nodes (27.6%) than in unstained lymph nodes ( 10. 8% ) in group 1 and in control group ( 16. 9% ). The differences were also statistically significant ( x2 = 6. 034, P = 0. 016; x2 = 5. 142, P = 0. 023 ). Postoperative afferent loop obstruction developed in one case in group 1. Conclusions Lymphatic mapping guided D2 radical gastrectomy plus lymphadenectomy increases the number of lymph nodes dessected and improves the efficiency of positive lymph nodes excision for patients of advanced gastric cancer.

Objective To investigate the feasibility of transient blocking of both pulmonary artery and veins for surgical treat- ment of central lung cancer with stage Ⅲ to preserve the normal pulmonary.Methods Firstly,the relation of the pulmonary artery, the lung neoplasm and the enlarged mediastinal lymph nodes was investigated.If the hilum of lung remained frozen,the pericardium was opened and the pulmonary artery,the upper and lower lobe pulmonary veins were dissected.Then those three vessels were blocked.When the pulmonary cireulation was stopped,bloodless lobectomy and pulmonary artery angioplasty and/or anastomosis were performed.Then the blockers were released,and pulmonary circulation was restored.The time of blocking was(35?15)minutes (16～66 minutes).Results All 20 patients suffer from stage Ⅲ central lung cancer,which' s the hila of lung remained frozen,re- ceived complete resection of the tumor.The normal functioning pulmonary tissue in the 20 patients was preserved instead of pneumone- ctomy.The average amount of bleeding was 256 ml(180～420 ml)during operation.All 20 patients recovered well.Conclusion Transient blocking of both pttlmonary artery and veins for surgical treatment of stage Ⅲ central lung cancer is and innovation in surgical technique,which makes the operation safe and easy.This technique may provide a chance to patients,with poor cardio-pulmonary function.In addition,this technique widens the surgical indications for patients suffering from lung cancer.

Objective:To analyze the effect of thoracoscopic subsegmental resection under the guidance of three dimensional(3D)computed tomography bronchography and angiography(3D-CTBA)for resection of pulmonary nodules.Methods:A total of 40 patients who underwent 3D-CTBA-guided thoracoscopic subsegmental resection in Nanjing Jiangbei Hospital of Nantong University from January 2020 to October 2021 were selected as the observation group,and other 35 patients who underwent 3D-CTBA-guided thoracoscopic pulmonary segmentectomy were selected as the control group.The intraoperative and postoperative conditions,and the incidence of postoperative complications of the two groups were observed.Results:The differences of amount of intraoperative blood loss,average margin width,postoperative drainage,retention time of drainage tube between observation group and control group were significant(t=8.644,2.862,10.03,3.277,P<0.05),respectively.The numbers of occurring postoperative chest leakage,pulmonary infection and hemoptysis in observation group and control group were respectively"3,1,1"and"2,1,2".The incidences of complications of two groups were respectively 12.5%and 14.29%,without statistical significance between the two groups(P>0.05).Conclusion:3D-CTBA-guided thoracoscopic subsegmental resection can shorten the operation time,and reduce intraoperative blood loss and the injury of tracheas and blood vessels,and improve the postoperative recovery of patients.